Letter of Medical Necessity for TMS & Ketamine

Partnering With Your Insurance to Get You the Care You Deserve

When you’re struggling with treatment-resistant depression, finally finding an effective option like TMS or ketamine therapy can be life-changing. But many patients face a common barrier right away:
Will insurance approve it?

At Bella Vida TMS, we work directly with your insurance company to make sure they do.

We handle all the paperwork, including the Letter of Medical Necessity, and take care of the authorization process for you—so you can focus on getting better, not fighting with your health plan.

In this guide, we’ll explain what a Letter of Medical Necessity is, how it applies to both TMS and ketamine, and what to do if your insurance says no.

What Is a Letter of Medical Necessity?

A Letter of Medical Necessity (LMN) is a clinical document that explains:

Why a treatment—like TMS or ketamine—is medically necessary
Your diagnosis and mental health history
Which other treatments you’ve already tried
Why this therapy is the next best option for you

Insurance companies use this letter to decide whether they will authorize and cover your treatment. It’s one of the most important tools for getting approval.

Who Writes the Letter?

At Bella Vida TMS, we write and submit the letter for you as part of your intake process.

This letter is created by one of our licensed providers after a full psychiatric evaluation. We ensure it includes everything your insurance company needs to see.

What Makes TMS and Ketamine Medically Necessary?

✅ TMS Therapy

TMS (Transcranial Magnetic Stimulation) is considered medically necessary when:

You have major depressive disorder (MDD)
You’ve tried at least two antidepressants without success
You may have also tried therapy or other medications
Your depression is moderate to severe and affects your daily life
You’re unable to tolerate medication side effects

TMS is FDA-approved for depression and recognized by most insurance providers as a covered treatment when these criteria are met.

✅ Ketamine Therapy (Spravato®)

Spravato®, the FDA-approved version of ketamine, is medically necessary if:

You have treatment-resistant depression
You’ve failed at least two oral antidepressants
You’re receiving treatment under medical supervision
Other medication options have not worked or caused side effects

Because Spravato® is FDA-approved, most major insurance companies—like Aetna, Cigna, Blue Cross, and Medicare—will cover it when medical necessity is documented.

💡 At Bella Vida TMS, we are REMS-certified to administer Spravato® and submit all necessary documentation to insurance on your behalf.

What If I’m Seeking IV or Oral Ketamine?

IV or oral ketamine is often not covered by insurance because it’s considered “off-label.” That means it’s still medically useful, but not yet FDA-approved for depression.

Even if your insurance won’t cover these options, our team will:

Clearly document why this treatment is needed
Provide a Letter of Medical Necessity
Help you understand out-of-pocket costs
Explore alternatives like Spravato® or TMS, which may be covered

What If My Insurance Denies the Treatment?

Don’t panic. Insurance denials happen—but they’re not the end of the road.

At Bella Vida TMS, we:

✅ File appeals with updated documentation
✅ Conduct peer-to-peer reviews with insurance doctors
✅ Resubmit with additional clinical data if needed
✅ Offer covered alternatives like TMS or Spravato®
✅ Help you understand financing options when applicable

We have years of experience advocating for patients and have helped hundreds get their treatment approved after initial denials.

What’s Included in the Letter?

Here’s what we include in your Letter of Medical Necessity:

Your diagnosis (e.g., major depressive disorder)
Description of your mental health history and symptoms
Documentation of treatment failures (e.g., SSRIs, therapy)
Clinical justification for TMS or ketamine therapy
Safety and efficacy data from peer-reviewed studies
Our provider’s credentials and recommendation
Supporting notes, labs, or documentation as needed

How Bella Vida TMS Makes This Easy

When you start care with us:

We evaluate your mental health and insurance coverage
We verify your benefits and identify any prior authorization needs
We write and submit your Letter of Medical Necessity
We work with your insurance until we get an answer
If denied, we help you appeal and explore alternatives

No stress. No delays. Just expert support from a team that truly cares.