Which insurances do you accept?
For adult patients, we currently accept HMSA, HMSA Quest, UHA, Blue Cross Blue Shield, Medicare, HMAA, Aetna, MDX, and Coventry. With appropriate referrals, we can also see Kaiser Permanente patients. For child and adolescent patients, we accept HMSA (except HMSA Quest), UHA, and Blue Cross Blue Shield.
Unfortunately, we do not accept HMA, United/UHC/UBH, Alohacare, or Ohana (or any Quest/medicaid other than HMSA).
What are your self-pay rates?
Most medication management sessions (including suboxone management) are $150, with an additional charge for labs if needed, except for the initial appointment which takes longer, and is usually $250. For TMS see below.
How long does TMS take to work?
Typically, a patient will undergo about 20-30 treatments, 5 days a week over 4-6 weeks. Each treatment takes about 30-50 minutes. By the end of the 4-6 weeks, most will have significant improvement or complete resolution of their depressive symptoms. Once the initial course is finished, usually about 6 more treatments are performed over the following 3 weeks with decreasing frequency.
How do I know it’s working?
We follow patients with regular questionnaires about their depression symptoms. Patients should have improvement in their
ability to sleep, to enjoy everyday activities, and to concentrate. They should have increased energy, and less sadness and anxiety. Some patients respond more quickly, within a few weeks, but many respond more towards the end of the course. It’s a very individual response.
Does insurance cover it? What is the cost if it doesn’t?
Some insurance companies such as HMSA and Coventry will authorize treatment relatively quickly under certain circumstances. Others insurance companies may require an appeal process, and some, such as Medicare based insurances, have routinely denied coverage.
If the insurance company does not immediately approve the TMS treatments, a patient can still begin the process of treatment but would have to pay out of pocket until the appeal process finishes. At that time, the insurance company, if they eventually approve the treatment, will reimburse the expense. Typically, an entire out-of-pocket course of TMS would run between $8,000 to $12,000 depending on the duration of treatment required.
How effective is it?
In open labeled trials, it appears to have remission rates higher than antidepressants in similar open label trials. However, these studies are using TMS alone. In real practice, TMS can be used in conjunction with psychotherapy, antidepressants, exercise, and/or natural remedies where some smaller studies have shown much higher rates of remission.
Can I get off medications if I have TMS?
Yes, if you choose to. However, if they are tolerable, but just not effective, you may elect to remain on them. TMS and medications may be more effective than either one alone.
What if I am pregnant?
TMS risks have not been fully studied on pregnant women. Thus, there may be unforseen risks with TMS in pregnancy. However, there is a growing body of scientific literature that suggests this may be an alternative to medications. The magnetic field used in TMS is almost non-existent a foot or two from the magnetic coil that is placed on the head. Thus the baby would not be exposed to any significant magnetic effects, nor would they be exposed to medications which are system wide and cross the placenta to the baby. This may have exciting implications for pregnant patients who need treatment for depression.