Are you considering ketamine infusions for mental health treatment or maybe you have already reaped the positive effects from them, but concerned about the financial aspect? One of the most common questions we get asked is “does my insurance cover ketamine infusions?”
It can be frustrating to finally find something that works for your treatment resistant depression, anxiety or neuropathic pain that insurance may not cover.
At NeuroMend Infusion Center, one of our goals is to get everyone who can benefit from this treatment help without cost being a deterrent. This blog post aims to provide valuable insights and tips on how to potentially get your ketamine infusions covered by insurance, ensuring that you can access this ground-breaking therapy without breaking the bank.
How much are Ketamine Infusions?
To make informed decisions about pursuing ketamine infusions, it's crucial to understand the associated costs. The cost of ketamine infusions can vary based on factors such as location, clinic reputation, and the number of sessions required. On average, a single session can range from $400 to $800, and a full course of treatment may involve multiple sessions.
While cost can be a significant consideration, the potential benefits of ketamine infusions for mental health should not be overlooked. Some individuals find that the improvement in their symptoms justifies the investment in their well-being. Additionally, exploring financing options or discussing payment plans with the clinic may help make ketamine infusions more financially manageable.
Understanding Insurance Coverage for Ketamine Infusions
The first question on everyone's mind is, "Is ketamine covered by insurance?" Unfortunately, the answer is not a straightforward yes or no. While ketamine infusions have gained recognition for their effectiveness in treating conditions like depression, anxiety, and chronic pain, insurance coverage varies.
Some insurance plans may cover ketamine infusions, while others may not.
Insurance has been limited by the fact that ketamine infusion therapy for treating depression and pain is currently considered off-label.
As a result this has hindered the opportunity for large trials needed for FDA approval, limiting the coverage from insurance companies. However, you should know that insurance coverage can vary greatly and some insurance companies are now considering this treatment as a covered expense.
It is a good idea to contact your insurance company prior to treatment to discuss the necessary arrangements for being reimbursed for your expenses.
Factors Influencing Insurance Coverage
Several factors come into play when determining whether your insurance will cover ketamine infusions.
Firstly, the specific diagnosis for which ketamine is prescribed can impact coverage. Some insurance plans may cover ketamine infusions for certain mental health conditions but not others. Additionally, the qualifications of the healthcare professionals administering the infusions can influence coverage.
Another crucial factor is the documentation provided by your healthcare provider. Insurance companies often require comprehensive documentation, including medical records, treatment plans, and evidence of the treatment's medical necessity. Working closely with your healthcare provider to gather and provide this information can significantly increase the chances of getting your ketamine infusions covered.
Testimonial from a Ketamine Infusion Patient
"I had my initial treatments in 2016 and heard insurance was unlikely to cover anything. It was disappointing, but, with how much better I was feeling, I had the energy to try and get something covered and I knew it was worth a shot.
First, I asked for the super bill at my infusion. The way it is broken down by different codes for very specific steps of the procedure (for example, a specific code for the office visit, for the IV and for the Ketamine itself) seems to be an aiding factor in the insurance company’s decision. After submitting the claim to my insurance after my treatments (my insurance is a Blue Cross Blue Shield PPO plan for reference), I called the customer service line.
After many long call waiting tunes, I was connected and explained the situation and educated the agent. I emphasized that they have covered many bills of unsuccessful treatments and that it would be more cost effective for them to cover Ketamine infusions that do work for me.
The agent I spoke with in this instance was kind and understanding, which is not always the case. She was able to get two follow up infusions reimbursed. However, I have spoken with agents who refuse to do so because of “policy”. I have heard that mentioning the gap in coverage of Ketamine providers has been a successful way patients with other insurances have gotten some infusions covered as well.
Tips to get your ketamine infusions refunded by insurance
Here are some important tips for working to get your infusions refunded by insurance:
1- Be persistent
You may get a different decision for each representative you talk to but keep trying and tell them your story about how well this treatment has worked for you and others.
2- Mention the insurance gap
Since insurances do not have a coverage plan for any Ketamine providers, you can point out that this is a gap in overall coverage.
In addition, you can suggest they treat the infusions as they would any out of network provider deal.
3- Don’t lose hope on coverage or yourself
If you are suffering and have been considering Ketamine infusions, call Neuromend Infusion Center today to help get you started. (877) 998-2002
4- Protect your Privacy
Ensure the clinic's respect your privacy and keep your records, data, and treatment information confidential. Your privacy matters, verify that your ketamine infusion clinic is 100% HIPAA Compliant.
NEUROMEND HAS COLLABORATED WITH THE FOLLOWING INSURANCE PROVIDERS TO HELP OUR PATIENTS SUBMIT FOR REIMBURSEMENT
- Blue Cross Blue Shield
- Physicians Mutual
- United Healthcare
*Although these insurance companies have approved reimbursement for certain treatments, it is important to note that coverage for your specific treatments is not guaranteed.
HOW NEUROMEND MAKES KETAMINE REIMBURSEMENT EASY
What Ketamine Paperwork Will I Need from Neuromend?
- A superbill.
- Occasionally, a specific form from your insurance is required to be filled out.
- Sometimes, additional supporting documentation is requested from your insurance provider.
Within What Time-frame Does Neuromend Process My Ketamine Paperwork?
- Virtually none.
- Upon your request, NeuroMend immediately fills out your paperwork.
- A few minutes later, you're set to sail.
What Is Neuromend's Typical Cost Per Treatment & Is the Reimbursement Process Actually Seamless?
- NeuroMend's typical Ketamine Treatment cost is $475.00 per treatment.
- We strive to make your reimbursement process smooth and seamless.
- Our NeuroMend team gently eases and advances this process by providing all necessary documentation.
Do I Process My Ketamine Reimbursement Paperwork or Will Neuromend Do This for Me?
- We will gladly provide you with your superbill and any required documentation. However, please note that we do not handle the submission of this paperwork to insurance companies.
On occasion, patient follow-up is required. We are happy to help. The below are some of the instances where we an be of assistance:
- We are not directly involved in coordinating phone calls, but we are more than willing to engage with insurance companies if they reach out to us with any inquiries.
- Seeking assistance or guidance from NeuroMend if needed within the reimbursement process.
READY TO SEE IF KETAMINE CAN HELP YOU?
Experience the life-changing benefits of Ketamine at NeuroMend Infusion Center. Our expert team is committed to providing the highest standard of care for those struggling with mental illness. With a focus on improving your overall quality of life, we offer a safe and comfortable environment for you to receive these innovative therapies. Don't let mental illness hold you back - If you or a loved one is struggling with mental illness, reach out to NeuroMend Infusion Center to see how Ketamine can help you live a happier, healthier life.
Disclaimer: As of September 29, 2023, NeuroMend no longer offers Spravato treatments. We apologize for any inconvenience and encourage you to consult with our team or your healthcare provider for alternative options.
*Insurance carriers have up to one year to reverse their decision on payment.
We are an Evidence-Based Center of Excellence and the leading provider of Ketamine Infusions, IV Infusions and Ketamine Consulting Services for Ketamine Clinics and IV Therapy Clinics.
We Provide Effective Treatment For The Following Conditions: Major Depressive Disorders, Post-traumatic Stress Disorder (PTSD), Bipolar Depression, Suicidal Ideations, Obsessive Compulsive Disorder (OCD), Chronic Migraines, Severe Anxiety, Fibromyalgia