Will Your Insurance Company Help Cover Your Ketamine Therapy?Ketamine treatment and at-home therapies are increasingly being used for the off-label treatment (outside FDA-approved usage) of conditions like depression, mood disorders, substance abuse, and chronic pain. Esketamine, another form of ketamine-derived medication, is FDA-approved for treatment-resistant depression and major depressive disorder with suicidality and should be covered by most insurance.
Understanding the intricacies of what parts of ketamine therapy are and aren’t covered by medical insurance can be complicated. While this article is meant to clarify things as much as possible, it is always best to contact your insurance company directly to know exactly what your coverage looks like.
What to Know About Ketamine Insurance Coverage
Unfortunately, your insurance may not cover ketamine infusion therapy at this point. However, your insurer may cover some part of the visit, such as the office fee, consultation, or psychiatric care.
This is largely because the off-label use of ketamine is so new. While other treatment modalities, such as SSRIs (Selective Serotonin Reuptake Inhibitors), have been used for mental health for decades, ketamine has only been gaining recognition as a mental health treatment in the last few years. While some insurers provide coverage for off-label medication, others may not. As always, you should contact your insurance company for details.
This is largely because the off-label use of ketamine is so new. While other treatment modalities, such as SSRIs (Selective Serotonin Reuptake Inhibitors), have been used for mental health for decades, ketamine has only been gaining recognition as a mental health treatment in the last few years. While some insurers provide coverage for off-label medication, others may not. As always, you should contact your insurance company for details.
How to Verify Insurance for Ketamine Therapy
Before booking a session, contact your insurer to see if they will cover any costs. They might not explicitly cover ketamine treatments, but they could offer coverage for treatments like psychiatric care and the office visit itself.
Reach out, explain your situation, and see if they can help. Your insurance company will tell you how much of a deductible you need to pay before their coverage kicks in.
You should also inquire about out-of-network coverage, if applicable. This means you receive treatment outside of the insurer’s network of healthcare providers. Initially, you’ll pay the charges yourself, and your insurer will reimburse you partially or fully. This is typically only applicable to certain plans.
Reach out, explain your situation, and see if they can help. Your insurance company will tell you how much of a deductible you need to pay before their coverage kicks in.
You should also inquire about out-of-network coverage, if applicable. This means you receive treatment outside of the insurer’s network of healthcare providers. Initially, you’ll pay the charges yourself, and your insurer will reimburse you partially or fully. This is typically only applicable to certain plans.
