- 21297 Foothill Blvd, Ste 203 Hayward, CA 94541 (by appointment only)
- (415) 636-9700
- hello@exxceedwellness.com
Depression can return after a successful course of TMS, and most insurance plans anticipate that. Coverage for a second acute course, usually called re-treatment, is common when you responded the first time, symptoms have returned,
Read MoreTMS is FDA-cleared as an adjunct treatment for obsessive-compulsive disorder, so coverage for OCD is legitimate rather than experimental. It is, however, narrower and less uniformly covered than TMS for major depression. Plans generally require
Read MoreIf the clinic you want is not in network with your plan, you are not automatically out of options. Many PPO plans reimburse a share of out-of-network care after a separate deductible, and a superbill
Read MoreWith a complete submission, most California plans decide a standard prior authorization request for TMS or Spravato within a few days to about two weeks. California law also provides for expedited review when waiting would
Read MoreBefore you start TMS or Spravato, three things decide whether treatment is covered: whether the benefit exists on your plan, whether you meet the medical necessity criteria, and whether the authorization is submitted with complete
Read MoreAnthem Blue Cross plans in California generally cover Spravato (esketamine) for treatment-resistant depression when medical necessity criteria are met, and prior authorization is required in essentially all cases. Approval turns on three things: documented treatment-resistant
Read MoreNearly every insurance decision about TMS or Spravato turns on one phrase: an inadequate response to two adequate antidepressant trials. Patients are often surprised to learn that medications they took for years may not count.
Read MoreAnthem Blue Cross plans in California generally cover TMS therapy for major depressive disorder when medical necessity criteria are met, and prior authorization is nearly always required. The deciding factor is documentation: your plan wants
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