Is TMS Covered by My Insurance?

What to Know About Referrals,

Pre-Authorizations and Out-of-Network Coverage

Transcranial Magnetic Stimulation (TMS) has become an increasingly popular option for those struggling with treatment-resistant depression, anxiety, OCD, and other mental health conditions. But while the effectiveness of TMS is well-established, one of the most common questions we hear from patients is: “Will my insurance cover TMS therapy?”

Let’s walk through what you need to know, from referrals and authorizations to out-of-network options - so you can feel confident taking the next step.

1. Most Major Insurers Do Cover TMS

Many insurance companies now recognize the clinical effectiveness of TMS and include it in their mental health benefits - especially for conditions like depression and OCD that haven’t responded well to medication or therapy alone.

At Inspire TMS Denver, we work with a wide range of plans, including:

• Anthem/Blue Cross Blue Shield
• Aetna
• United Healthcare
• Cigna
• Tricare
• Medicare and others

If you’re unsure about your specific coverage, you can use our Cost & Insurance Estimator Quiz to get a personalized breakdown in just a few minutes.

Download Your Roadmap to TMS

Want a clear picture of what to expect?

Download the TMS Treatment Roadmap by Sydney

2. Referrals Are Often Required

(But Not Always)

Depending on your plan, a referral from your primary care physician or mental health provider may be required. If you already have a diagnosis of major depressive disorder (MDD), anxiety, or OCD, this can help streamline the approval process.

At our clinic, we’ll walk you through the exact documentation needed based on your plan.

3. Pre-Authorization: A Key Step

Most insurance plans require pre-authorization before starting TMS. This step confirms that the treatment is medically necessary and meets the plan’s specific guidelines.

Don’t worry - our team handles this for you. We gather all necessary documentation, submit it to your insurer, and follow up to ensure nothing slips through the cracks.

4. Out-of-Network Doesn’t Mean Out of Reach

If Inspire TMS Denver is considered “out-of-network” under your plan, you still have options:

• Some plans offer partial reimbursement for out-of-network providers.
• We can provide documentation to support a “single case agreement”, a special approval that allows you to receive care from an out-of-network provider.
• Our sliding scale pricing can also help make TMS more affordable in self-pay situations.
  

5. We’re Here to Help

Navigating insurance can be stressful - but we do this every day, and we’re here to guide you.

• Still unsure if you’re covered?
• Not sure where to start?

Take our free quiz or schedule a quick call with one of our coordinators to get clarity within minutes.

Next Steps

Take the Cost & Insurance Estimator Quiz

Book a Free 10-Min Call With the Doctor