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Quick summary (the short answers) Medicare: Often covers TMS for treatment-resistant major depressive disorder when the plan’s clinical criteria (such as prior medication trials) are met and prior authorization is approved. Inspire routinely helps patients with Medicare benefits checks and authorizations. Medicaid: Coverage varies by state . Some state Medicaid plans cover TMS with strict medical necessity criteria; others do not. Inspire collects your insurance details and runs a state-specific benefits check. Pre-authorization: Nearly always required. Insurers want documented prior treatment attempts, objective symptom measures (PHQ-9), and a psychiatrist’s letter of medical necessity. Inspire will run the authorization for you once you approve.

What Inspire TMS Denver accepts and what that means In-network / insurer relationships: Inspire states it accepts major commercial insurers and works with patients to obtain coverage - including Medicare and Tricare, where criteria are met - and the clinic routinely runs benefits checks and prior authorizations on a patient’s behalf. That means you don’t need to guess whether a policy will pay - Inspire will verify for you. Common Medicare / commercial rules (examples): Different payers have specific clinical criteria. For example (from the clinic’s pricing documents): Anthem - typically requires failure of two different antidepressants from different classes (or intolerance). Medicare -may require failure of one previous antidepressant (or intolerance) Tricare - covers TMS when it is medically necessary and prior less-intensive interventions have failed or are inappropriate. These examples illustrate typical insurer frameworks, but your plan may differ. What’s often covered vs not covered: Commonly covered: FDA-cleared TMS for treatment-resistant major depressive disorder when prior treatment criteria are met and prior authorization is approved. Often not covered (or considered “off-label”): accelerated TMS protocols , certain indications (some anxiety/insomnia/experimental uses), and some PTSD/anxiety uses; these may require self-pay or sliding-scale payment. Inspire notes it offers sliding-scale/self-pay for off-label care and for financial hardship.

How TMS is different: a quick, plain-language explanation TMS uses a magnetic coil to stimulate specific areas of the brain associated with mood and emotional control. It’s non-invasive, does not require anesthesia, and is performed in an outpatient setting. Instead of changing chemistry like antidepressants or providing a rapid but medication-based reset like ketamine , TMS aims to retrain brain circuits by repeatedly activating under-performing regions so they function more normally over time. Inspire’s patient materials stress this neuroplastic, circuit-based approach and describe mapping, stimulation and physician oversight used to personalize treatment.

What is “treatment-resistant depression” (TRD)? Clinically, TRD is commonly defined as depression that has not sufficiently responded to an adequate trial of two different antidepressants (from at least two different classes) given at therapeutic doses and durations. Some insurers and clinical guidelines use this “two-trial” rule when deciding whether to cover advanced treatments like TMS. Medicare and commercial payers may have slightly different wording (for example, Medicare sometimes requires one failed antidepressant; Anthem often requires two). The key idea is consistent: TRD means standard medication strategies haven’t produced an acceptable response.

Your main options while you’re in Colorado Short/accelerated courses If you have very limited time, accelerated TMS (iTBS or compressed protocols) lets clinics deliver many sessions over a few days rather than weeks. Inspire offers accelerated regimens (MagVenture-capable) and lists accelerated TMS as an option for patients who need a fast course, but note: accelerated courses are often not covered by insurance and usually require self-pay or sliding-scale arrangements. Maintenance or “rescue” sessions Maintenance or “rescue” sessions If you’ve completed a full course and need occasional boosters to maintain gains while away, maintenance TMS (weekly, biweekly, or monthly sessions) is common. Clinics also provide rescue or extension courses when symptoms re-emerge. Maintenance often requires a clinician discussion to set frequency, and many insurers do not routinely cover maintenance so clinics may offer packages or discounted session bundles. Full course continuation If your original acute course was interrupted, many clinics will pick up or adjust your plan; this typically requires review of previous mapping and progress measures and coordination with your home TMS provider. Inspire performs mapping and tailors plans to each patient’s needs.