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Athena Care
Does United HealthCare Cover TMS Therapy?

Does United HealthCare Cover TMS Therapy?

Does United HealthCare Cover Transcranial Magnetic Stimulation (TMS)?

Yes, United HealthCare (UHC) insurance covers Transcranial Magnetic Stimulation (TMS) in Tennessee when the patient meets specific criteria.1

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How to Verify United HealthCare Coverage for TMS Therapy

Athena Care has multiple TMS clinics in Tennessee and is in-network with most major insurance plans. Filling out our free and confidential online insurance verification form is the easiest and most efficient method to determine the specifics of your United HealthCare TMS coverage.

Let our highly experienced, expert care coordinators handle the challenges of contacting your insurance carrier for more information about TMS therapy United HealthCare coverage. A care coordinator will review your policy and clearly explain your options after you’ve completed the form. Rest assured, all submitted or discussed information remains confidential.

United HealthCare TMS Coverage Eligibility Policy

UHC transcranial magnetic stimulation coverage is proven and medically necessary for the treatment of patients 18 years of age or older when the patient meets the following criteria:2

  • Confirmed diagnosis of major depressive disorder (MDD)
  • Failure of a psychotherapy trial
  • Resistant depression does not respond to at least four antidepressants

United HealthCare TMS coverage does not apply for the use in patients with the following non-behavioral conditions, including but not limited to:

  • Alzheimer’s disease
  • Chronic neuropathic pain
  • Dystonia
  • Epilepsy
  • Headaches
  • Parkinson’s disease
  • Stroke
  • Tinnitus

What is Transcranial Magnetic Stimulation?

Transcranial magnetic stimulation is a non-invasive procedure involving a device that creates magnetic fields used to stimulate the brain. These fields seek to change the brain’s chemistry for the treatment of depression.

A doctor will place the magnetic coil on your head near your forehead. The electromagnet sends out a non-painful magnetic pulse that affects nerve cells in the portion of your brain that regulates mood and depression. It aims to activate less active brain regions in depressed people.3 The average session lasts 45 minutes, with 20 to 30 treatments advised for best results.

People who have certain medical implants are not eligible for TMS therapy. Interactions between magnetic fields and metal implants or gadgets might cause problems. Additionally, if you have stents, implanted stimulators, a pacemaker, a medication pump, cochlear implants, or gunshot fragments in your body, you may not be eligible for TMS as a treatment option. Discussing these concerns with your doctor before the surgery is crucial to avoid adverse outcomes.

TMS is also not recommended for people with certain medical disorders. Those having a history of seizures or bipolar disorder, for example, should avoid TMS therapy. It is also not recommended for women who are pregnant.

Finally, inform your TMS doctor about any prescription or over-the-counter medications, supplements, or vitamins you’re taking. They’ll need to ensure that TMS therapy is safe for you.

How Much Does TMS Cost Without Insurance?

The prices of TMS therapy without insurance are listed here, albeit they may vary depending on location and other considerations. Furthermore, they may not reflect actual treatment costs or what you might pay in Tennessee.

TMS therapy sessions typically cost between $400 and $500 per session.4 Because most people require multiple TMS sessions to achieve optimal outcomes, the total cost of TMS treatment could be close to $15,000.

Sources

  1. “Transcranial Magnetic Stimulation.” United HealthCare, 22 Apr. 2022, www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-medical-drug/transcranial-magnetic-stimulation.pdf.
  2. United HealthCare. (2021). Level of Care Guidelines: UnitedHealthcare Transcranial Magnetic Stimulation. United HealthCare Community Plan. Retrieved June 11, 2022, from https://www.uhcprovider.com/content/dam/provider/docs/public/commplan/tn/behavioral-health/TN-BH-Guide-Transcranial-Magnetic-Stimulation.pdf.
  3. Mayo Clinic Staff. “Transcranial Magnetic Stimulation – Mayo Clinic.” Mayo Clinic, Mayo Foundation for Medical Education and Research (MFMER), 27 Nov. 2018, www.mayoclinic.org/tests-procedures/transcranial-magnetic-stimulation/about/pac-20384625.
  4. Porter, Robert. “What Does TMS Therapy Cost? TMS Information | BetterHelp Advice.” Betterhelp, BetterHelp, 20 Apr. 2022, www.betterhelp.com/advice/therapy/how-much-does-tms-therapy-cost

If you suspect that you or someone you love suffers from mental health disorders, contact Athena Care today.

One of our friendly associates will help you get the help you need. Take this first step to feel better and take control. 

(615) 320-1155