INSURANCE QUESTIONS
Which insurances do you accept?
Every provider has their own individual credentials, so they can each accept varying insurances, but we have accounted for that in our application process, so you can instantly see the doctors that are available within your insurance network while you are filling out your form. You can indicate your order of preference in the application form. At least one of our providers is able to accept HMSA, HMSA Quest, Blue Cross Blue Shield, Medicare, HMAA, Aetna, MDX, and Coventry. With appropriate referrals, we can also see Kaiser Permanente patients.
Unfortunately, we do not accept HMA, UHA, United/UHC/UBH, Alohacare, or Ohana (or any Quest/Medicaid other than HMSA or Kaiser).
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.
TMS QUESTIONS
How long does TMS take to work?
Typically, a patient will undergo about 20-30 treatments, 5 days a week over 4-6 weeks. The first two appointments are longer than the rest of the treatments. The first is an intake interview lasting about an hour. Once authorized, the second appointment also has a one-hour duration. There is a calibration session that must be completed during the second appointment in order to assure effective treatment. Each of the following appointments are set for a 15-minute time slot with the treatment lasting approximately 6-7 minutes of that time. This timing is based on using the latest protocols with Theta Burst Stimulation. Sometimes the appointment will involve filling out a questionnaire to monitor progress. By the end of the 4-6 weeks, most patients 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. Many patients continue to improve in the weeks or months after the treatment.
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 TMS? What is the cost if it doesn’t?
Almost every insurance company covers treatment with TMS, but most (including HMSA) require prior authorizations that have very clearly defined rules, usually necessitating at least four medication trials during this depressive episode. Medicare covers TMS with no prior authorization required, but an expectation that antidepressant trials have been attempted. Kaiser Permanente also covers TMS if authorized internally.
If your insurance company does not immediately approve the TMS treatments, we can still begin the process of treatment but this would have to be 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 could run as little as $7200 as of November 2020, a significant decrease from prior pricing.
How effective is it?
In open labeled trials, the remission rates are higher than antidepressants in similar open label trials. However, these studies are using TMS alone. It is even more effective to utilize TMS 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, you may usually elect to stay on your medication regimen if preferred. 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 unforeseen 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.