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How to Determine The Out-of-Pocket Cost of Transcranial Magnetic Stimulation (TMS)

Nov 25, 2022
child confused by cost of TMS
Out-of-pocket costs for TMS vary widely. Learn what factors are considered when making this determination.

Since becoming approved by the FDA in 2008, Transcranial Magnetic Stimulation (TMS) has become increasingly popular as a treatment for mood disorders ranging from major depression to Obsessive-Compulsive Disorder (OCD). The high rates of effectiveness, non-invasive approach, and paucity of side effects of TMS make it a very appealing option for many doctors and patients. Yet the question that still remains on many patients’ minds is: how much will a course of TMS cost for me?

The answer – as is often the case with all things that involve medical insurance – is: it depends. 

 

Insurance Coverage for TMS Is Growing

Without doubt, over the past several years, more and more health insurance plans have begun to cover TMS. Still, the out-of-pocket cost of TMS can vary widely. The best way to determine your particular out-of-pocket cost is to receive a psychiatric assessment by a TMS specialist, followed by a benefits investigation by their insurance experts. Dr. Elia Gonzalez-Rodriguez and her team at Pacific Phoenix TMS have extensive experience making these determinations.

At Pacific Phoenix TMS we welcome the following health insurance plans: 

  • Blue Cross Blue Shield
  • Tricare
  • Aetna
  • ComPsych
  • Cigna
  • First Choice
  • Pacific Source
  • MHN
  • United Healthcare / UMR / Optum
  • Premera
  • Anthem
  • Providence

 

The Cost of TMS Varies Widely Based on A Number of Factors

Nevertheless, it can be helpful for patients to gain a better understanding of the process that goes into such determinations. The cost is basically driven by two factors: your individual medical history and the terms of your specific insurance plan.

On the medical front, considerations include:

  • your age
  • the severity of your mood disorder
  • the number of alternative treatments that have failed to produce results
  • other factors

On the insurance front, many factors are at play as well – assuming that your plan does cover TMS. They include:

  • in-network vs. out-of-network status
  • size of your remaining annual deductible
  • amount/frequency of the copays or coinsurance charged by your plan
  • size of your out-of-pocket maximum
  • other factors

Depending on your out-of-pocket cost, payment plans may also be available through our clinic, or can be arranged through AdvanceCare or CareCredit.

 

What if My Insurance Does Not Cover TMS? What if I Don't Have Medical Insurance Coverage?

If your insurance plan does not cover TMS, or if you don't have medical insurance, you can still receive TMS treatment. Your cost will depend on the details of your treatment, such as the number of sessions required. Payment plans may also be available through our clinic, or can be arranged through AdvanceCare or CareCredit.

If you are suffering from depression, OCD, or PTSD, don’t wait – contact Pacific Phoenix TMS today and take an important step on the road to recovery!

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