If you’ve been struggling with depression and haven’t found relief through traditional treatments, you may have heard about Transcranial Magnetic Stimulation (TMS) therapy. This FDA-cleared, non-invasive treatment has helped thousands of people find relief from depression symptoms. But one of the most common questions people ask is: “Do I need a referral to start TMS therapy?”
The answer depends on your insurance coverage and the TMS provider you choose. Let’s break down what you need to know about referrals, insurance requirements, and how to have a productive conversation with your doctor about whether TMS therapy might be right for you.
If you are going to a TMS provider outside of your network, you may need a referral. If you are going to a TMS provider who is in network, you will not need a referral. Insurance companies require documentation that you’ve tried other depression treatments first, typically at least two antidepressant medications that haven’t provided adequate relief. This doesn’t mean you need a formal referral from your primary care doctor, but it does mean your treatment history needs to be documented.
Some insurance plans require prior authorization before they’ll cover TMS therapy. This process usually involves your TMS provider submitting documentation to your insurance company showing that you meet the criteria for treatment. This documentation typically includes your diagnosis, medication history, and current symptoms.
At Advantage TMS, we are IN NETWORK with United Healthcare, Aetna, Cigna, Evernorth, Optum, Oscar, Beacon/Carillon, Tricare, Medicare, and all Blue Cross Blue Shield and other commercial insurance plans – which means you will not need a referral to start TMS at Advantage TMS.. Our team works directly with your insurance company to handle the authorization process, making it easier for you to access the care you need.
You should consider discussing TMS therapy with your doctor if you’re experiencing any of these situations:
You’ve tried multiple antidepressants without success. If you’ve been on two or more different antidepressant medications and haven’t found the relief you need, TMS therapy might be an effective alternative.
You’re experiencing intolerable side effects from medication. Many antidepressants come with side effects like weight gain, sexual dysfunction, nausea, or fatigue. TMS therapy is non-systemic, meaning it doesn’t circulate through your bloodstream, so it avoids these common medication side effects.
Your depression symptoms are interfering with daily life. If you’re having trouble getting out of bed, maintaining your job, or enjoying activities you used to love, it could be time to explore additional treatment options.
You’re concerned about taking medication long-term. Some people prefer non-medication treatments or want to reduce their reliance on antidepressants. TMS can be used alongside medication or, in some cases, may allow you to reduce your medication dosage under your doctor’s supervision.
Talking to your doctor about TMS therapy doesn’t have to be intimidating. Here’s how to approach the conversation:
Come prepared with information. Before your appointment, research TMS therapy (our website has lots of useful information) so you understand the basics of how it works. TMS uses magnetic pulses similar to those used in an MRI to stimulate areas of the brain associated with mood regulation. Treatment sessions typically last 19-37 minutes and are conducted five times per week over six weeks.
Be honest about your current treatment. Share openly about how your current antidepressant is working (or not working) and what side effects you’re experiencing. Your doctor needs this information to determine if TMS might be appropriate for you.
Describe your symptoms in detail. Don’t minimize what you’re going through. If you’re having trouble sleeping, experiencing persistent sadness, struggling with concentration, or having thoughts of self-harm, tell your doctor. The more specific you can be about how depression is affecting your daily life, the better your doctor can help.
Ask specific questions. Come to the appointment with a list of questions about a referral for TMS therapy. You might ask: “Based on my treatment history, am I a candidate for TMS?” or “What would the insurance authorization process look like?” or “How would TMS fit into my current treatment plan?”
Request documentation. If you decide to move forward with TMS, ask your doctor if they can provide documentation of your treatment history. This can help speed up the insurance authorization process.
Once you’ve discussed TMS with your doctor, the next step is scheduling a consultation with a TMS provider. At Advantage TMS, we offer same-day free consultations (in person or virtual) to help you learn more about whether TMS therapy is right for you.
During your consultation, you’ll meet with our team to discuss your mental health history, current symptoms, and treatment goals. We’ll gathering medication history from you and work with your insurance company to determine coverage. If you’re a good candidate for TMS and your insurance approves treatment, you can typically start therapy within 5-7 days of your consultation.
Our team is available to answer questions and provide immediate help throughout the process. We understand that reaching out for help can feel overwhelming, which is why we’ve designed our consultation process to be as straightforward and supportive as possible.
Most major insurance companies now cover TMS therapy for patients who haven’t responded adequately to antidepressant medications. The insurance authorization process typically takes a few days, depending on your insurer.
If your insurance doesn’t cover TMS or you don’t have insurance, self-pay options with financing are available. Our team can walk you through the costs and payment options during your free consultation.
The journey to finding effective depression treatment can feel long and frustrating, but you don’t have to navigate it alone. Whether you need help talking to your doctor about TMS therapy, understanding your insurance coverage, or simply learning more about TMS therapy, the team at Advantage TMS is here to support you.
TMS therapy has helped hundreds of people in the Clearwater and Tampa Bay area find relief from depression over the past nine years. With extended hours from 8 AM to 8 PM Monday through Thursday, plus Friday and Saturday availability, we make it easy to fit treatment into your schedule.
If you’re ready to explore whether TMS therapy might be right for you, contact us today to schedule a free consultation. You can reach us at (727) 600-8093 or visit our office at 28465 US Highway 19 N, Suite 202, Clearwater, FL 33761.
Finding relief from depression is possible. Let us help you take the next step.
Kendrick T. (2021). Strategies to reduce use of antidepressants. British journal of clinical pharmacology, 87(1), 23–33. https://doi.org/10.1111/bcp.14475
Ferguson J. M. (2001). SSRI Antidepressant Medications: Adverse Effects and Tolerability. Primary care companion to the Journal of clinical psychiatry, 3(1), 22–27. https://doi.org/10.4088/pcc.v03n0105
Our office is closed December 25th for Christmas and January 1st for New Years Day. If you have any questions or urgent requests, please email us at info@advantagementalhealth.com.
Please fill out the form if you have a patient interested in learning more about TMS treatment. We appreciate the referral and partnership.
Next Steps:
• Our TMS Coordinator will contact the patient to schedule a complimentary information session.
• If the patient decides to seek TMS treatment with Advantage TMS, we will communicate with you when necessary and the patient will continue to work with you while receiving treatment.
Questions?
• Please don’t hesitate to contact us at 727-600-8093 or info@advantagementalhealth.com
