Don’t Panic—Denial Isn’t the End
You’ve finally found a treatment that could actually help—TMS therapy or ketamine—but then your insurance provider says: “Not covered.”
It’s frustrating, confusing, and disheartening.
But here’s what we tell our patients every day at Bella Vida TMS:
A denial is just a hurdle—not a dead end.
We work with patients across Phoenix, Gilbert, and Glendale to turn denials into approvals—and when insurance still won’t budge, we help make treatment affordable through CareCredit financing, cash-pay options, and payment plans.
Let’s walk through your next steps.
Why Insurance Denies TMS or Ketamine
TMS and ketamine are both evidence-based treatments for treatment-resistant depression, but insurance companies still deny coverage for several common reasons:
🔹 Incomplete Documentation
Missing a Letter of Medical Necessity or detailed medication history.
🔹 Not Meeting Criteria
You haven’t yet tried two antidepressants or psychotherapy, according to their policy.
🔹 “Off-label” Use
IV or oral ketamine is not FDA-approved for depression, so most insurers don’t cover it.
🔹 Administrative Error
Mistakes happen—incorrect codes, provider status, or clerical issues can trigger a denial.
Step-by-Step: What to Do Next
✅ 1. Don’t Take It Personally
Denials are frustrating but common. They can often be overturned with a strong appeal.
✅ 2. Request a Written Explanation
Ask your insurer for a denial letter and review the reason they gave. This will guide the appeal.
✅ 3. Let Bella Vida TMS Handle It
We’ll take over communication with your insurance provider. Our team will:
- Review and correct your documentation
- Update your Letter of Medical Necessity
- Coordinate a peer-to-peer review if needed
- File an official appeal on your behalf
We do all of this at no cost to you as part of our patient advocacy.
Appealing the Denial
Most insurance companies have a multi-step appeal process. Here’s what we do:
📄 First-Level Appeal
We submit new records, updated clinical notes, and research supporting the medical necessity of TMS or Spravato®.
☎️ Peer-to-Peer Review
Our provider speaks directly with an insurance doctor to explain your case.
📝 Second-Level or External Review
If necessary, we help escalate your appeal to an independent reviewer or your state’s insurance department.
What If I’m Denied for Ketamine?
❌ IV or Oral Ketamine
These forms are not FDA-approved for depression, so they’re typically not covered by insurance. However, they’re still safe and effective when prescribed responsibly.
If you’re denied, we can:
- Provide a detailed Letter of Medical Necessity
- Refer you to a trusted off-label ketamine provider
- Offer cash-pay pricing and CareCredit financing
✅ Spravato® (Esketamine)
This FDA-approved nasal spray is covered by many major insurance plans when prior authorization requirements are met. If your insurer denies it, we help you appeal—fast.
Can I Still Get Treatment If My Insurance Won’t Pay?
Yes. If your insurance won’t approve your TMS or ketamine treatment, you still have affordable options.
💳 CareCredit Financing
We accept CareCredit, a healthcare credit card that offers:
- Flexible monthly payments
- 0% or low-interest promotional periods
- Instant application approval in many cases
💵 Cash-Pay Discounts
For patients paying out of pocket, we offer discounted self-pay rates on TMS and refer to providers offering the same for ketamine.
📆 Payment Plans
Ask us about custom monthly payment options so you can start treatment now without financial stress.
Alternatives That May Be Covered
If TMS or ketamine is denied, you may still qualify for:
- Spravato® (if not already tried)
- TMS therapy, if only ketamine was denied
- Medication management with a psychiatric provider
- Psychotherapy referrals
We’ll help you explore every pathway to care.
Why Choose Bella Vida TMS?
We know this system. We fight for our patients. And we offer multiple paths to recovery.
Here’s what you can count on:
- ✅ Free insurance verification
- ✅ We submit all authorizations and appeals
- ✅ We provide Letters of Medical Necessity
- ✅ We accept most major insurance plans
- ✅ We offer CareCredit and payment options
You’re never alone in this process.
What to Do if Your Insurance Denies TMS or Ketamine Coverage
If your insurance denies TMS or ketamine treatment, don’t give up. Let us help you appeal, advocate, and if needed—get creative with payment options. The care you need is within reach.
At Bella Vida TMS, we combine compassion with expertise to make mental health care accessible—whether your insurance cooperates or not.
References
- Centers for Medicare & Medicaid Services (CMS) – National Coverage Determination (NCD) for TMS Therapy
https://www.cms.gov/medicare-coverage-database/view/ncd.aspx?ncdid=374 - U.S. Food & Drug Administration (FDA) – FDA Approval of Spravato® for Treatment-Resistant Depression
https://www.fda.gov/news-events/press-announcements/fda-approves-new-nasal-spray-medication-treatment-resistant-depression - Spravato® (Esketamine) Official Website – Insurance and Coverage Information
https://www.spravato.com - National Institute of Mental Health (NIMH) – Major Depression Treatment Overview
https://www.nimh.nih.gov/health/topics/depression - American Psychiatric Association (APA) – Practice Guidelines for the Treatment of Patients With Major Depressive Disorder
https://psychiatryonline.org/guidelines - HealthCare.gov – Your Right to Appeal an Insurance Decision
https://www.healthcare.gov/appeal-insurance-company-decision/ - CareCredit – Financing Options for Mental Health Services
https://www.carecredit.com
