Increasing Awareness and Insurance Coverage for TMS Therapy

Increasing Awareness and Insurance Coverage for TMS Therapy

By: Dr. W. Scott West, Chief Medical Officer, Nashville Neurocare Therapy

When you think of depression treatment, what comes to mind?

Talk therapy, maybe? Or antidepressants? Perhaps you picture affirmations and yoga.

Chances are, TMS Therapy isn’t at the top of your list. TMS Therapy is a leading non-drug treatment for depression. Though it might not be as well-known as cognitive behavioral therapy and medication, all major health insurance payers cover TMS Therapy, making it an accessible alternative treatment path if talk therapy or antidepressants are not working for you.

The Need to Know: TMS Therapy

What is TMS Therapy?

  • TMS stands for Transcranial Magnetic Stimulation
  • Uses magnetic-pulse technology to stimulate the parts of your brain that regulate mood and behavior
  • FDA Cleared in 2018 to treat major depressive disorder (MDD) that has not responded to a previous course of antidepressant medication
  • TMS treatment that is non-invasive, in-office treatment, and 100% drug-free
  • Not electroconvulsive therapy (more commonly known as “shock therapy”)
  • Modulates neural circuits to regulate your own moods for lasting, sustainable relief

Why TMS Therapy might be right for you:

TMS Therapy and Insurance

While awareness for TMS Therapy is growing and health insurance payers are covering this treatment, navigating your health insurance plan can sometimes feel confusing and overwhelming as insurance companies decide on their own criteria. For some, the complexity of health insurance and stress over what your payer will or will not cover can become a barrier to receiving the care necessary. Luckily, this is a surmountable barrier.

At Nashville Neurocare Therapy, we accept a range of insurance carriers and offer flexible payment options to provide the care you need. When you decide to pursue treatment with our office, our experienced insurance consultants will work with your health insurance company to determine your benefits, coverage, out-of-pocket costs, reimbursements, and alternative payment options.

Working Toward More Accessible Coverage

In the past decade, our healthcare system has made great strides in making TMS Therapy a more accessible treatment option. However, there are still improvements to be made.

Medicare was the first insurance to cover TMS in Tennessee in 2012. Two to three years later, other insurance companies developed coverage. At the time, most companies had requirements of severe depression, failure of four or more antidepressants, and a course of psychotherapy.

Blue Cross Blue Shield of Tennessee (BCBST) is one of the state’s largest and most influential health insurance payers. They have impactful decision-making power on a state level regarding coverage policies for TMS Therapy. However, BCBST’s coverage policy for TMS Therapy limits access to treatment for members who would likely benefit from TMS.

Our team at Nashville Neurocare Therapy has personally made several efforts to encourage BCBST to have a reasonable TMS coverage criterion. In early 2021, BCBST indicated they concluded they would align with local Medicare coverage. When the local Medicare coverage changed their coverage to two failed antidepressants earlier in 2022, Nashville Neurocare Therapy recommended BCBST follow their earlier conclusion and align with the local Medicare criteria—our team has yet to hear back from BCBST.

For most antidepressants, it takes at least four to eight weeks to determine efficacy and many psychiatrists recommend longer to truly determine a drug’s impact. Completing and documenting four trials not only takes a lot of time— time that could be spent pursuing alternative, effective care— but weaning on and off different medications is a very demanding process physically, mentally, and emotionally. It changes your chemistry and involves side effects that can be very painful and disorienting. Medication is a viable and successful treatment tool for many patients, but for those for whom it does not work, alternatives must be accessible and available without unnecessary obstacles.

Medicare—and other major payers like Cigna and Anthem—only require two trials of failed psychopharmacologic agents before TMS Therapy will be covered by their plans. Two trials allow providers to ensure that medication is not a viable option for a patient without exacerbating the time their patients are without successful treatment. One of the Medicare jurisdictions, First Coast, has posted a comment period on their proposed TMS criteria of severe depression and failure of one antidepressant.

In addition to helping patients and doctors thrive, reducing the criteria from four trials to two is also a win for these insurance payers. A recent comparative study explores the cost-effectiveness of TMS Therapy versus antidepressant therapy for those experiencing treatment-resistant depression. The study concludes that “although both pharmacotherapy and rTMS (repetitive TMS) are clinically effective treatments for major depressive disorder, rTMS is shown to outperform antidepressants in terms of cost-effectiveness for patients who have failed at least two adequate courses of antidepressant medications.” These results should incentivize payers to reduce their criteria, to help their members get the relief they need without sacrificing the needs of their organization.

We have seen changes to cause more awareness of depression and continue to see evidence of TMS Therapy’s effectiveness, safety and durability. Insurance changes have been painfully slow but are occurring.

Would You Like to See Change?

If you’re interested in seeing your insurance company modify their policy to make TMS Therapy more accessible for more people, please take two minutes to answer our 2-question survey here. If you’re searching for a depression treatment beyond medication or talk therapy, schedule your free TMS Therapy screening today. Together, we’ll review your insurance plan and find a healing path forward with TMS Therapy.

About the Author: Dr. W. Scott West

Nationally recognized, board-certified psychiatrist, Dr. W. Scott West, blazed the trail for TMS therapy in Tennessee as the first physician to offer this advanced technology in 2010. With 30+ years experience in clinical depression, Dr. West leads the Nashville Neurocare team.

  • Board Certified Psychiatrist
  • Specialty: Certified TMS Psychiatrist since 2010
  • Diplomate: The American Board of Psychiatry and Neurology
  • Distinguished Life Fellow: American Psychiatric Association
  • Residency: Vanderbilt University, Hospital Department of Psychiatry
  • Medical School: University of Tennessee, Knoxville, Center for the Health Sciences
  • Hospital Affiliations: St. Thomas Hospital