Is Ketamine Covered by Insurance?

Depression is a common medical condition that can encompass serious, life-threatening symptoms. Ketamine can be a potentially life-saving treatment for individuals with suicidal thoughts. Sadly, many people who can benefit from ketamine are unable to afford the treatment.

At MNH TMS & Psychiatry Services we get a number of calls asking, “Does insurance cover Ketamine?” We now have hope of a possibility that insurers recognize the value of this potentially life-saving treatment.

Intravenous Ketamine

Intravenous ketamine was first used in the ’60s as an anesthetic medicine to treat soldiers in the Vietnam War. Due to the lower incidence of respiratory depression, emergency rooms use ketamine for procedural sedation in both adults and children. After nearly half a century, ketamine continues to preserve its unique corner in medicine.

Anesthesiologists and pain specialty doctors primarily use ketamine. As a result, ketamine is gaining much attention in psychiatry medicine for its anti-depressive and anti-suicidal benefits. Ketamine proves to be an extremely effective treatment for major depression, bipolar disorder, and suicidal behavior. 

Ketamine is particularly useful for patients with severe major depressive disorder seeking transcranial magnetic stimulation (TMS) when suicidal ideations are present. Since insurance does not cover TMS in the presence of active suicidal thoughts, the acute symptoms can be treated with ketamine for the immediate relief of such life-threatening thoughts. Also see: Ketamine for Depression

Insurance coverage for TMS therapy and Ketamine

Nearly all insurance plans, commercial, and government cover transcranial magnetic stimulation (TMS). However, TMS is contraindicated for patients experiencing the most severe depressive symptom – suicidal ideations or thoughts.

Most patients, especially today, are reluctant to hospital admission for safety. This is a population of patients that health care providers are most apprehensive about and where ketamine becomes a viable and needed treatment approach.

At present, Allways Health Partners covers intravenous (IV) ketamine for the diagnosis of treatment-resistant major depressive disorders or severe suicidal ideations. Primary post-traumatic stress disorder (PTSD) accompanied by severe depressive symptoms may also be considered as a covered diagnosis.

Like TMS therapy, prior authorization is necessary. However, this shows great promise toward the possibility of insurance coverage for IV ketamine in psychiatric medicine.

Allways Health Partners utilizes Optum to provide mental health services to their beneficiaries. Optum is one of the largest behavioral health payer networks in the United States. To access the network’s IV ketamine medical policy for treatment-resistant depression, click HERE.

TMS Directory can assist you in locating a ketamine doctor, clinic, or provider near you. Just send us your contact information and a short message and one of our specialists will be in touch within 24-hours. You may also contact us directly at 1-833-TMS-HELP.