Don’t Let Insurance Paperwork Delay Your Recovery
Finding the right treatment for depression can feel like a breakthrough—especially when you learn about proven options like Transcranial Magnetic Stimulation (TMS) or ketamine therapy.
But before you begin, your insurance company may require something called prior authorization—a process that can feel confusing, frustrating, and slow.
At Bella Vida TMS, we help patients in Phoenix, Gilbert, and Glendale navigate this step with confidence. In fact, we handle it all for you.
This guide explains what prior authorization is, why it’s important, and how to make sure your treatment doesn’t get held up by red tape.
What Is Prior Authorization?
Prior authorization (PA) is when your insurance company requires approval before it will pay for a specific treatment—like TMS or ketamine.
It’s their way of saying:
“We need proof this is medically necessary before we agree to cover it.”
While the process can feel bureaucratic, it’s routine for TMS and Spravato®, the FDA-approved form of ketamine therapy.
When Do You Need Prior Authorization?
You typically need prior authorization when:
- You’re receiving TMS therapy for major depression
- You’re being prescribed Spravato® (esketamine nasal spray)
- Your plan classifies TMS or ketamine as a higher-cost or specialty treatment
Plans from Aetna, Cigna, UnitedHealthcare, Blue Cross Blue Shield, Tricare, and most Medicaid and Medicare Advantage programs usually require it.
💡 Medicare (traditional) often does not require prior authorization for TMS, but each plan is different.
What Treatments Does This Apply To?
✅ TMS Therapy
TMS is FDA-approved for treatment-resistant depression. It uses magnetic pulses to stimulate brain activity without medication.
Most insurers will require prior authorization, and they’ll want to see:
- A formal diagnosis of major depressive disorder
- A history of two or more failed antidepressants
- Documentation that you’ve tried therapy or counseling
- A recommendation from a licensed psychiatric provider
✅ Spravato® (Esketamine Nasal Spray)
Spravato® is the only FDA-approved form of ketamine therapy for depression and suicidal thoughts.
Insurers typically require:
- Diagnosis of treatment-resistant depression
- Documentation of prior medication failures
- That the medication be administered in a REMS-certified clinic (Bella Vida TMS is certified)
- A prior authorization request with medical records and provider certification
What About Other Forms of Ketamine?
IV, IM (intramuscular), oral, and lozenge-based ketamine are not FDA-approved for depression. That means:
- They’re considered off-label by insurance companies
- Prior authorization is usually not available
- These treatments are typically self-pay only
However, our team may still write a Letter of Medical Necessity to help support your case—or recommend alternative covered treatments.
What Does Bella Vida TMS Do to Help?
We take the burden off your shoulders. Our team:
- Verifies your insurance benefits
- Collects and submits all required documentation
- Writes and submits your Letter of Medical Necessity
- Follows up with your insurer until a decision is made
- Coordinates peer-to-peer reviews, if needed
- Keeps you informed every step of the way
We don’t charge anything extra for this service—it’s part of how we support you.
What If You’re Denied?
If your prior authorization is denied, don’t worry—we have options:
- Appeal the denial with stronger documentation
- Schedule a peer-to-peer review between our provider and the insurer’s reviewer
- Submit additional psychiatric evaluations or medical history
- Explore covered alternatives like Spravato® or TMS (if one was denied)
- Offer CareCredit financing, cash-pay options, or payment plans
Many initial denials are reversed on appeal—especially when we handle them.
Tips for Speeding Up the Process
- Be open about your full medication history
- Share records of past therapy or mental health support
- Let us know about any hospitalizations or suicidal symptoms
- Start your intake paperwork right away so we can get moving fast
Understanding Prior Authorization for TMS and Ketamine Treatment
Prior authorization might sound like a hurdle—but with the right team behind you, it’s just another step forward.
At Bella Vida TMS, we help patients get access to TMS and ketamine-based treatments without the stress. We fight for your coverage, file the paperwork, and support your journey toward healing.
References
- Centers for Medicare & Medicaid Services (CMS) – National Coverage Determination for Transcranial Magnetic Stimulation (TMS)
https://www.cms.gov/medicare-coverage-database/view/ncd.aspx?ncdid=374 - U.S. Food & Drug Administration (FDA) – Spravato® Approval for Treatment-Resistant Depression
https://www.fda.gov/news-events/press-announcements/fda-approves-new-nasal-spray-medication-treatment-resistant-depression - Spravato® REMS Program – Janssen Pharmaceuticals – Prescribing and Safety Information
https://www.spravato.com - National Institute of Mental Health (NIMH) – Depression and Treatment-Resistant Depression Overview
https://www.nimh.nih.gov/health/topics/depression - HealthCare.gov – Understanding Prior Authorization and Your Rights to Appeal
https://www.healthcare.gov/appeal-insurance-company-decision/ - Blue Cross Blue Shield, Aetna, and UnitedHealthcare – Medical Policies for TMS and Esketamine Coverage
(Available through individual insurer portals) - CareCredit – Financing Options for Mental Health Treatments
https://www.carecredit.com
