Getting Insurance To Pay For Your Ketamine Treatments

For those suffering from mental health conditions such as Depression PTSD, OCD, Bi-Polar, and Suicidal Ideation

UPDATE (6/17/20): KWC Dallas – Fort Worth is now contracted with Blue Cross Blue Shield for pain treatments.

Whether you are just now considering Ketamine infusions for depression and other mental health conditions or you have already reaped the positive effects from this breakthrough therapy, cost can be a huge factor in your decision to move forward. I definitely understand the frustration of finally finding something that works for your Treatment Resistant Depression but that insurance may not cover. At Ketamine Wellness Centers, one of our goals is to get everyone who can benefit from this treatment the therapy they deserve without cost being a deterrent.

All insurance is different and while there is no guarantee that your particular provider will reimburse you for any or all your treatments, I want to share with you all how I got some of my treatments covered by insurance and provide some tips that have worked for other Ketamine patients in the past. I had my initial treatments (called Stabilization Treatments) in 2016 and heard that insurance was unlikely to cover anything. It was disappointing but with how much better I was feeling, I had a newfound energy to try and get something covered and I knew it was worth a shot.

First, I asked for the superbill at the time of 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, a code for the IV and a code for the Ketamine itself) seems to be an aiding factor in the insurance company’s decision to reimburse the patient. After submitting the claim to my insurance post-treatment, I called the customer service line.

For the record, my insurance provider at this time was Blue Cross Blue Shield (PPO plan). At the time of writing this, state and federal insurance plans such as Medicare, Medicaid, TriCare, and other Veteran Affairs-affiliated plans do not accept Ketamine Infusion Therapy as a covered treatment.

Anyway, after many on-hold waiting tunes, I was connected to somebody and explained my situation by educating the agent. I emphasized that they have covered the cost of many other types of (unsuccessful) treatments and that it would be more cost effective for them to cover Ketamine infusions, since they actually work wonders 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 refunded. However, I have also spoken with agents who refuse to do so because of “policy” or because “the system denied it” but are unable to explain the reasoning why.

I believe that mentioning the gap in coverage of Ketamine providers has been a successful way patients have gotten some infusions covered as well. Additionally, some insurances have automatically reimbursed our patients a percentage of the cost simply after the patient submits our superbill. In fact, I can think of quite a few patients who have experienced this right here in the KWC Colorado clinic. While it is not guaranteed, in the past, insurances including Aetna, UMR and Blue Cross Blue Shield have sent our patients checks covering anywhere from 25-60% of the billable codes! Not bad at all for a non-FDA approved therapy.

Ultimately, we are all waiting for the day that this life changing treatment is covered by all insurance providers without question. In the meantime, don’t give up hope of getting some insurance compensation. Here are some important tips for working to get your infusions refunded by insurance:

Be persistent

You may get some reimbursement right away or you may have to call and advocate for yourself. You may get a different decision for each representative you talk to (frustrating, I know) but keep trying and tell them your story about just how well this treatment has worked for you. Education is vital in spreading awareness of Ketamine’s effectiveness to not only insurance companies and agents, but the general public as well.

Mention the insurance gap

Since insurance companies do not have a coverage plan for Ketamine providers, you can point out that this is a gap in overall coverage. Alternatively, you can suggest they treat the infusions as they would any out of network provider deal (this is generally how they treat it when patients have received automatic reimbursement after submitting).

Don’t lose hope on coverage or yourself!

If you are suffering and have been considering Ketamine infusions, call Ketamine Wellness Centers today to help get you started.

Keep in mind that insurance carriers have up to one year to reverse their decision on payment. KWC can provide a superbill to any of our patients who request one, so that they can submit a claim for insurance reimbursement. Please call us at 855-KET-WELL for more information. 

Further Reading:  What is a superbill and will it help cover the cost of my ketamine infusion treatments?