If you’re exploring your TMS therapy insurance coverage, it’s helpful to understand how major insurance companies approach this treatment. While each provider has its own specific policies, most require patients to meet certain criteria before approving TMS therapy.

Here’s a brief overview of the coverage policies from the major insurers accepted by Advantage TMS:

• – United Healthcare: Covers TMS therapy for patients diagnosed with major depressive disorder (MDD) who have tried and failed at least two antidepressants.
• – Aetna: Typically covers TMS for patients with treatment-resistant depression who have not improved with standard treatments.
• – Cigna: Provides coverage under similar conditions, often requiring a history of failure with other treatment methods like medication and talk therapy.
• – Evernorth: A division of Cigna, Evernorth follows similar coverage guidelines, focusing on patients with documented treatment-resistant depression.
• – Optum: Offers coverage for TMS therapy but generally requires pre-authorization and detailed medical documentation.
• – Oscar: Oscar insurance plans also provide coverage for TMS therapy under specific conditions, often requiring medical necessity documentation.
• – Beacon/Carelon: Offers mental health benefits, including coverage for TMS therapy, particularly for patients with MDD.
• – Tricare: Covers TMS therapy for military members and their families under certain conditions, often requiring pre-authorization.
• – Medicare: Medicare covers TMS therapy for patients with treatment-resistant depression, with certain guidelines that must be met before approval.
• – Blue Cross Blue Shield: BCBS, including Florida Blue and Federal Blue Cross Blue Shield, provides coverage for TMS therapy, typically requiring a pre-authorization and a history of failed treatments.