If you’re searching for how to get Ketamine Infusions covered by insurance, you’ve probably heard that ketamine is one of the most cutting-edge treatments for depression that won’t respond to other treatments.
You might be pretty perplexed if you’ve heard that it’s the first instance in the developing field of psychedelic medicine or if you’ve heard that it’s a tranquillizer for horses.
You’ve probably seen the astounding response rates of almost 80% after only a brief course of infusions. A highly efficient treatment that lowers emergency department and hospital visits, as well as saves suicide, will undoubtedly be covered by insurance. Right?
Yes and no, but the majority is no. But to some extent, yeah. Three main topics will be explored in relation to the issue of insurance coverage for ketamine and how to get Ketamine infusions covered by Insurance
But first before going briefly going into how to get ketamine infusions covered by insurance, let’s get to know if Ketamine infusions are covered by insurance.
Are ketamine infusions covered by insurance?
Ketamine infusions are typically not covered by major insurance providers. Billing codes for injections or EKGs, for example, may be used by some clinics to “get away” with billing for infusions.
However, as ketamine is not FDA authorized for indications related to depression, anxiety, PTSD, or any other mental health condition, they really shouldn’t.
Ketamine infusions won’t ever be reimbursed by insurance, according to a statement issued by various insurance companies, including Blue Cross Blue Shield of North Carolina.
Blue Cross Blue Shield of Illinois established a page on their website where it explicitly stated that billing ketamine infusions to insurance are considered fraud.
Other Blue Cross Blue Shield businesses (such as Kansas) have released comparable declarations.
Some healthcare professionals may issue superbills for ketamine infusions, which the patient can submit to their insurance carrier in the hopes of receiving payment.
Even though some insurance companies do pay for these, they typically only pay for the “evaluation and management” portion of the session rather than the infusion itself.
It’s likely that the insurance provider would not actually compensate the patient for that visit if they looked closely enough to ask for data.
There are some unexpected exceptions to getting ketamine insurance coverage, though. Blue Cross Blue Shield of Massachusetts, a different BCBS plan, has published a written policy and authorization procedure for receiving coverage for ketamine infusions.
Despite the fact that the procedure was a little challenging (as is sometimes the case when insurance companies cover new therapies), our facilities have previously been successful in obtaining this authorization.
We are eager to take part in Enthea, a special benefit for some employer-sponsored health plans, as it is another potential choice.
We are able to accept insurance payments for ketamine infusions and ketamine-assisted therapy through Enthea. But at the moment, the perk is relatively uncommon. In the future, we anticipate that more plans will be able to provide it.
How to Get Ketamine Infusions Covered By Insurance?
Blue Cross Blue Shield of Massachusetts, a different BCBS plan, has published a written policy and authorization procedure for receiving coverage for ketamine infusions.
Despite the fact that the procedure was a little challenging (as is sometimes the case when insurance companies cover new therapies), our facilities have previously been successful in obtaining this authorization.
We are eager to take part in Enthea, a special benefit for some employer-sponsored health plans, as it is another potential choice.
We are able to accept insurance payments for ketamine infusions and ketamine-assisted therapy through Enthea. But at the moment, the perk is relatively uncommon. In the future, we anticipate that more plans will be able to provide it.
Ketamine Therapy Insurance Not Technically Covered but Aspects of Treatment Can Be?
Although your insurer might not technically pay for ketamine treatments, some parts of the therapy might.
In 1970, the FDA approved ketamine as an anaesthetic. It is “off-label” to use ketamine infusion therapy to address diseases associated with chronic pain and mental disorders.
Simply put, this only means that there is a clinical basis for utilizing it to treat ailments other than those for which it was initially approved.
In the United States, it is quite common to prescribe pharmaceuticals outside of their approved labels; 33% of all psychiatric meds and nearly 25% of all prescriptions are done thus.
However, this may result in insurance coverage limitations.
Is Off-Label Ketamine Use a Possibility for Insurance Coverage?
There are numerous obstacles to overcome even if it is feasible to get ketamine paid by insurance while it is used off-label for mood disorders and pain issues.
One of them is that pharmaceutical firms oppose the use of ketamine for therapeutic purposes because it would lower sales of conventional antidepressants, which are still very profitable for them despite being only slightly more effective than ketamine.
Because it is an off-label use, insurance companies frequently refuse to recognize ketamine as a reliable treatment for depression, other mood disorders, and chronic pain. In an effort to cut costs, they typically refuse to pay for treatments whenever possible.
At KCLA, we believe that by covering ketamine rather than some of the less beneficial therapies they presently cover, many of which are more expensive than ketamine infusions, they would actually save money.
Fortunately, there is a growing recognition in the medical and psychiatric sectors that ketamine therapy is an essential practice that needs to be “mainstream.”
There is an urgent need for solutions to the depression and suicide crises in the United States and the rest of the world.
In the US and around the world, depression is the main factor in disability.
There is a higher probability that insurers would think about covering other ketamine treatments, like intravenous ketamine infusions, as a result of the FDA’s recent approval of Spravato, also known as esketamine (which comprises 50% of ketamine’s molecules), for the treatment of depression.
What Is The Cost Of Ketamine Therapy?
Due to a lack of insurance coverage, ketamine therapy may be more expensive than other types of treatment.
However, if you’re able to finance these treatments on a short-term basis, you might end up saving money in the long run. Prioritize your mental health when deciding how much it will cost to treat your depression.
- knowledge of insurance coverage
- A comparison of treatment providers’ prices
- Look for funding possibilities
- Finish the cost-benefit analysis.