How Long Does Insurance Take to Approve TMS or Spravato?

With 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 seriously jeopardize your health, which shortens that window substantially. The variable that actually determines your timeline is not the insurer’s speed. It is whether the request arrived complete the first time.

On this page: Standard timelines · Expedited review · What causes delays · After approval

What is a typical timeline?

Benefits verification usually takes a day or two. Assembling documentation takes as long as it takes to collect your medication history, which is the step patients can most influence. Once submitted, standard determinations commonly return within days to roughly two weeks. Add time if the plan requests additional records, because that resets the clock rather than pausing it.

When can review be expedited?

California regulations require faster handling when a standard timeline would seriously threaten your life, health, or ability to regain maximum function, or would subject you to severe pain. Expedited review is requested by your clinician with clinical justification, not by asking politely. If your situation is urgent, say so plainly at your evaluation so it can be documented and requested appropriately.

What causes the delays?

In order of frequency: incomplete medication history, especially trials from former prescribers; missing standardized symptom scores; no documentation of dose and duration, so trials cannot be judged adequate; a request filed under the wrong benefit type, medical versus pharmacy; and missing confirmation of a REMS-certified site for Spravato. Almost all of these are preventable at intake. Our guides to TMS prior authorization and verifying your insurance beforehand cover the checklist.

What happens after approval?

Approvals are typically issued for a defined number of sessions or a treatment window, not indefinitely. If your course extends or you need re-treatment later, a new authorization is usually required, which our guide to maintenance and re-treatment coverage explains. If the request is denied instead, the appeal path is covered here. To start the process with your history reviewed properly, an evaluation is the first step, in Hayward or by telehealth across California.

This article is educational and is not legal or personalized medical advice. Timelines vary by plan and circumstance. Reviewed by Nefretiri Abat, PMHNP-BC, JD.