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
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.
Kayla is an Office Administrator at the Littleton-Denver, Colorado clinic of Ketamine Wellness Centers
Further Reading: What is a superbill and will it help cover the cost of my ketamine infusion treatments?
It’s good to know more about getting ketamine treatment. I like how you said that being persistent with different representatives will help. I’ve heard that this treatment is really helpful, so being persistent makes sense. It’s probably worth it!
Ridley, thank you so much for your feedback and kind words. We appreciate it! Feel free to check out some of our success stories at http://www.ketaminewellnesscenters.com/about/ketamine-testimonials and if you have any additional questions, we have patient liaisons that are available to help at anytime. Feel free to give us a call (855-KET-WELL). Thanks!
So are you saying you were successful in getting it covered by BCBS? Do you know what specific CPT codes you used?
THanks
Hi Michael,
Thank you for your message. Kayla, a Patient Liaison in our Denver clinic, was successful in getting Ketamine therapy covered by her insurance. Depending upon your individual medical insurance plan and the nature of the diagnoses, some portion of the treatment may be eligible for reimbursement. To get a list of CPT codes, please feel free to give us a call at 855-KET-WELL and we will be more than happy to assist you!
Has anyone ever gotten Medicare to reimburse??
Ketamine Infusion Therapy for mental health conditions such as Depression is considered an “off-label” use and is not a service typically reimbursed by insurance companies. For pain diagnoses, some portion of the treatment may be eligible for reimbursement however it depends largely upon your individual medical insurance plan and the nature of the diagnoses. Feel free to give us a call at 855-KET-WELL, if you’d like to discuss insurance and financing further. Thank you!
Please contact us regarding experience with Medicare and Medicaid. My 34 yr old daughter has been under psychiatric care since age of 10 for bipolar illness. We are in Georgia and she is having her first infusion today. She is disabled and her only income comes from her disability payments each month. We are at her first ketamine infusion appt with her psychiatrist Dr Banov in Marietta, GA who she has seen for 15+ years at least. Cost will be a major deal. I am Sherri Giles, Mary’s mother, and could use any advice that might pertain to her situation.
Hi Sherri, thank you for you message. We really appreciate it! We’ve received your request and a Patient Liaison will be in touch shortly to answer your questions and along with my any additional resources you may need.