INSURANCE QUESTIONS
Which insurances do you accept?
We currently 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. Each treatment takes about 30-50 minutes by traditional treatment, or as little as 6-7 minutes if by Theta Burst Stimulation. 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 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, 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.