TMS and Anthem Blue Cross Blue Shield
A commonly asked question is whether Anthem Blue Cross Blue Shield will cover TMS (transcranial magnetic stimulation) treatment? The answer is yes provided that a prior authorization (permission from the insurance company) is obtained. Anthem Blue Cross Blue Shield states that TMS is considered “medically necessary” (a legalese term – meaning they’ll pay for it) when the following conditions are met:
#1 – Has a diagnosis of severe major depressive disorder
#2 – The individual has had 4 trials of psychopharmacologic agents (fancy for antidepressants) and has failed to respond to them OR unable to tolerate 4 different agents from 2 different
#3 – Of the 4 medication trials, 2 of the antidepressants have come from 2 different classes (SSRI, SNRI, Wellbutrin, Remeron, etc)
#4 – Trial has included at least 2 evidence based therapies (such as CBT)
#5 – Trial of at least 2 different augmentation strategies
Of all the insurance companies, Blue Cross Blue Shield seems to be the most rigid in terms of what they required prior to approval of TMS. However, if you are suffering with depression and have tried all of the strategies to treat your depression above, then TMS maybe a good alternative treatment for you. If you think that TMS would be a good fit for you and meet the above criteria, then the first step would be to schedule an appointment with Dr. Tanner to go over your medical and psychiatric history. You can go to our contact page here, and we’d be happy to discuss your case.
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