Understanding TMS Maintenance: How It Works and Insurance Coverage
Transcranial Magnetic Stimulation (TMS) has emerged as a revolutionary treatment for individuals struggling with depression and other mental health conditions, especially when traditional treatments haven’t provided relief. At Southeastern Psychiatric Associates TMS Center, we are committed to providing effective, evidence-based care to our patients. One crucial aspect of TMS therapy is the concept of TMS maintenance. In this blog post, we'll delve into what TMS maintenance entails, how it works, and whether it is covered by insurance.
What is TMS Maintenance?
TMS maintenance refers to ongoing sessions of Transcranial Magnetic Stimulation therapy designed to sustain the positive effects achieved during the initial course of treatment. Typically, a standard TMS treatment course involves daily sessions over several weeks. For many of those who have responded to TMS, the improvement is very long-lasting. But for some, symptoms return after a variable amount of time (several months to several years). Fortunately, studies show that about 84% of the time a followup treatment is successful. For those who do experience one or more recurrences, transitioning to a maintenance program is often the best path forward to prevent relapse and maintain the therapeutic benefits.
How Does TMS Maintenance Work?
TMS maintenance follows the same principles as the initial treatment, using magnetic pulses to stimulate nerve cells in the brain associated with mood regulation. The exact plan is individualized according to clinical considerations, insurance approvals and patient logistics.
Typically, we start to talk about maintenance when a patient who has successfully been treated first returns after a relapse. Our TMS coordinator will first approach the insurance company and assess how many visits we have to work with, and over what time period.
Once we see a robust response to the retreatment, we then start tapering the frequency of treatments, from five days a week for the active phase, to three times, two times and once a week, then every other week and even less frequently. It is a matter of individual response plus trial and error to find the lowest frequency of treatments needed to maintain wellness, but the range varies from every two weeks to every eight.
Is TMS Maintenance Covered by Insurance?
The coverage of TMS maintenance by insurance varies significantly between providers and individual plans. Here are some key points to consider:
Initial Coverage: Most insurance companies cover the initial TMS treatment course, especially for patients with major depressive disorder who have not responded to medication or psychotherapy.
Pre-Authorization: It’s crucial to obtain pre-authorization from the insurance company for maintenance therapy. This process involves submitting detailed medical records and treatment plans for review.
Maintenance Coverage: Insurance coverage for maintenance sessions is less straightforward. More and more insurers now cover maintenance treatments if they are deemed medically necessary, but this often requires thorough documentation and justification from the healthcare provider. Sadly, some still deny the request.
Using Approved Visits: Typically, insurance companies approve a block of 36 sessions for each course of treatment. If the insurer does not cover maintenance, we can often start to taper the frequency early (depending on how well the retreatment is going, of course) and save up some approved visits to use as maintenance treatments.
Out-of-Pocket Costs: If insurance does not cover maintenance sessions, patients may need to consider out-of-pocket payment options. Our team at Southeastern Psychiatric Associates TMS Center works closely with patients to explore all available options, including payment plans and financial assistance programs.
Conclusion
TMS maintenance is an important aspect of long-term mental health care for many patients. At Southeastern Psychiatric Associates TMS Center, we are dedicated to providing comprehensive support and guidance to help our patients navigate their treatment and insurance options.
If you have any questions or need more information about TMS maintenance therapy, please don’t hesitate to contact us. Our team is here to support you every step of the way on your journey to better mental health.
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