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The Ultimate Guide to TMS Therapy and Insurance Coverage

By 
Cristal Thomas

Transcranial magnetic stimulation is an alternative psychiatric treatment method that uses electromagnetic pulses delivered through a device coil to target areas of irregular brain activity. TMS is most effective for those with mental disorder symptoms that have proven to be resistant to psychiatric medications. For those dealing with persistent and severe mental health struggles, TMS offers a safe and powerful relief from symptoms. If you’re wondering about calculating the costs of TMS and finding insurance coverage, this article can help. Read down below to learn the following info about TMS coverage:

  • Is TMS right for you?
  • How to find insurance coverage for TMS
  • Tips for TMS patients
Man smiling at his reflection in a mirror
TMS can help improve mood and other cognitive functions. Image courtesy of Pexels.com.

Is TMS Therapy Right For You?

How Does TMS Work?

TMS modifies brain activity to alter communication between neurons, subsequently influencing various brain functions. Mood regulation and other executive functions are typically the targets of TMS pulses. With electromagnetic pulses permeating the skull to reach the brain, TMS is effective in reducing symptom severity in major depression, anxiety disorders, and other mental health conditions.

You typically receive TMS therapy in a TMS medical office or outpatient medical clinic. TMS is delivered by qualified technicians and physicians who specialize in the TMS intervention method. The non-invasive psychiatric treatment involves a secure and comfortable procedure during each session. The device used to deliver TMS pulses uses a coil to safely and effectively target areas of irregular brain chemistry in the patient. 

During the average TMS session, the TMS device’s coil is first placed above the seated patient’s head. The device makes loud clicking sounds as each of its magnetic pulses is delivered, and each pulse feels like light tapping against the patient’s head. It’s best for TMS patients to wear earbuds during each session to reduce the potential discomfort in response to the device’s clicking noises. Following each electromagnetic pulse, neuronal activity and communication is promoted in the brain. 

A patient’s initial TMS session will typically entail a technician calibrating the device to assess the patient’s physical tolerance for the magnetic pulses, making it easier for future sessions to be as comfortable as possible for each patient. Once a TMS therapy session ends, patients can leave and continue their days as planned. There are no issues with being able to drive or perform other daily activities post-session. 

Person holding out there hands with coins in their palm. A plant grows out of the coins in the palms.
With various insurance coverage options, TMS therapy is more affordable than ever. Image courtesy of Pexels.com.

TMS and Insurance Coverage

The Basics of Insurance Coverage 

For those who are concerned about the affordability of TMS therapy, don’t fret--most major insurance providers offer coverage for TMS. These providers include Medicare, Medicaid, Anthem Blue Cross, and countless others. 

Insurance policies give patients access to both in-network and out-of-network medical providers. In-network providers’ costs are covered at least partially by insurance, while out-of-network providers’ services aren’t covered by insurance at all. Out-of-network providers are sometimes able to contact your insurance provider to negotiate case-by-case coverage as well. 

To check on insurance coverage for TMS, you can either reach out directly to a TMS provider or contact your insurance company. Some insurance providers also have online, searchable directories of in-network medical services. Those receiving Medicare or Medicaid should check to make sure their state provides coverage for TMS specifically. If your state offers no insurance coverage for TMS treatment, don’t be afraid to contact state and local representatives to advocate for mental health coverage options. 

For those struggling to find in-network TMS providers, some insurers may use what’s called a “carve-out plan.” A carve-out plan allows the insured to attain a separate insurance plan for specific services that are excluded in their traditional policy. Within a carve-out plan, insurers can partner with mental health service vendors directly so that the insured can receive in-network benefits for these services. Check to see if your insurance provider offers these options for TMS coverage.

What Are the Costs?

Calculating the costs of insured TMS treatment can be tricky due to differences between insurance policies and companies. TMS treatment can either be fully covered by insurance or require the insured to at least pay a deductible, copay, or coinsurance. 

A deductible requires TMS patients to pay an amount determined by their policy before the insurance company will fully cover services. A copay is an amount that must be paid for each TMS session. Coinsurance requires the patient to share the costs of services with their insurance company--for example, if insurance covers eighty percent, then the patient must cover the remaining twenty percent. A TMS provider is able to contact your insurance company and help you determine the exact costs of TMS treatment. 

What to Do Before Treatment

Insurance providers ultimately determine the authorization process that has to be completed before TMS is performed. Though it varies per insurance company and plan, most of the process can be completed during a consultation appointment with a TMS provider. 

Typically, pre-authorization forms are completed and sent to your insurance company during the consultation. The information in these forms includes the patient’s medication and mental health treatment history. Some insurance providers may require a psychiatrist’s referral, and most require that patients have a history of treatment resistance to medications. Ultimately, it’s best for patients to reach out to their insurance companies and TMS providers for the most thorough understanding of how to start TMS. 

A bright white medical room with medical chair and medical equipment
Patients can make the most of their TMS therapy in and out of a clinic. Image courtesy of Pexels.com.

Tips to Make the Most of Your TMS Treatment

Before Treatment

  1. Drink caffeine

For those who don’t experience adverse effects with caffeine, it can be a great boost for your TMS sessions. Caffeine can stimulate the brain similar to how the pulses of a TMS device stimulate brain areas. A morning coffee can be enough to leave your brain super stimulated after a TMS session. 

  1. Stay hydrated

Outside of being a necessity in life, water also optimizes brain function along with the therapeutic effects of TMS on the brain. Water can also help combat feelings of fatigue that potentially follow a TMS session. 

  1. Be energized and awake

It’s essential that a TMS patient remains awake and alert during treatment sessions. The brain must be as alert as possible in order for the TMS device’s pulses to be effective. Be prepared to be up and energized prior to your sessions. 

  1. Consider talking during treatment

When the stimulating effects of TMS treatment are taking effect on the brain during treatment, the brain is at its peak potential for absorbing and processing information. Take advantage of your brain’s peak stimulation with some conversation during a session.

  1. Stick to your medication schedule

Patients can continue taking prescribed psychiatric medications while receiving TMS treatment. It’s vital that patients don’t deviate abruptly from their medication schedule--this not only jeopardizes their mental and physical health, but also can also lead to other adverse symptoms while receiving TMS. 

After Treatment

  1. Exercise and keep active

Exercising following TMS treatments can boost the mood and motivation regulating effects of TMS on the brain. Both exercise and TMS can kindle brain activity in areas for motivation, reward, and mood. Staying active can help optimize the effects of TMS on mental health symptoms. 

  1. Maintain your TMS session schedule

Just as it’s detrimental to deviate suddenly from a medication schedule, it’s also adversive to not maintain your scheduled TMS sessions. The number of sessions needed varies per treatment plan, but an abrupt interruption of these sessions can make it more difficult for the brain to acclimate and respond to TMS pulses. 

  1. Get a good night’s rest

A TMS session can sometimes leave patients feeling slightly fatigued or lulled. Make sure you set aside enough time to rest and fully re-energize the same day as a TMS session. Keeping up your energy and concentration throughout TMS sessions can further strengthen the therapeutic effects on your mental health.

  1. Ensure a healthy, well-balanced diet

The health and wellbeing of your brain is undoubtedly influenced by your diet. The more balanced and less processed your diet is, the more concentration and endurance your brain will maintain during TMS sessions. A good diet can help ensure you get the most from your TMS treatment. 

  1. Have patience with the TMS process

As with most mental health interventions, it takes time, patience, and commitment before noticeable changes take place in symptoms. TMS doesn’t give anyone instant and immediate relief from their mental struggles. Every patient experiences the rehabilitative effects at different paces. Always consult with your TMS physician if several sessions of TMS still aren’t producing results for you. 

If you’re considering starting TMS treatment for severe mental disorder symptoms, the process behind receiving TMS is easier than you may think. Though this article lays out the basics of how to initiate TMS treatment consultation, don’t hesitate to reach out to TMS clinics or your insurance provider for more information. TMS has become much more accessible and renowned as a psychiatric treatment option, and can provide amazing symptom relief for most treatment-resistant mental health patients. 

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