Perhaps your doctor has ordered a TMS (transcranial magnetic stimulation) treatment, that has been denied by your insurance company. Transcranial magnetic stimulation is a procedure that uses magnetic fields to stimulate nerve cells in the brain with the goal of improving depression symptoms. Because the procedure does not require surgery, it is considered a noninvasive procedure. TMS is generally only warranted when other depression treatments have not been effective. TMS has also been approved by the FDA to treat migraines and obsessive-compulsive disorder and to help people stop smoking. The treatment also shows promise to help those with epilepsy.
Repeated magnetic pulses are delivered via an electromagnetic coil placed against the scalp. These magnetic pulses stimulate nerve cells in the region of your brain involved in depression and mood control. “Deep TMS” is differentiated from TMS by the type of coil used; deep TMS coils are used for OCD and to Stop smoking. If you suffer from severe depression, then having TMS therapy denied by insurance can be frustrating. A treatment that could potentially help you get better seems beyond your reach. This is a time when you need a strong legal advocate like attorney Scott Glovsky. Scott fights for his clients every single day, helping them get the treatments they need and deserve. Your insurance company needs to hold up its end of the bargain, and Scott can help ensure that happens.
Why Might TMS Therapy Be Denied by Insurance?
TMS therapy denied by insurance could occur for a number of reasons. Perhaps a form you or your doctor’s office submitted to the insurer was filled out incorrectly, had errors, or was incomplete. The doctor’s office may also have miscoded the procedure. These are issues that can be resolved fairly simply. The procedure may be excluded under your policy, so it’s important that you read through your policy to determine whether TMS is included. You might also be required to obtain pre-authorization prior to having any procedure done.
In other cases, TMS therapy could be denied under the guise of being “not medically necessary,” “investigational,” or “experimental.” While these labels are sometimes valid, too often, it is the insurance company’s way of not paying for an expensive medical procedure. Since multiple sessions of TMS, spread out over several weeks, are usually necessary, the cost can be as high as $12,000. Many insurance companies will require “step” therapy, meaning before they will pay for TMS you will have to try other, less expensive treatments, such as anti-depressant drugs.
Specific Types of TMS Therapy That Might Be Denied
Whether your TMS therapy is used for major depression, to quit smoking, or for OCD, the treatment could potentially be denied. It is probably more likely to be denied when your doctor has prescribed the treatment for smoking cessation. Your insurance company may deem TMS not medically necessary since methods like using a nicotine patch are much less expensive. Any treatment that is less expensive is likely to be the treatment your insurance company prefers, so having attorney Scott Glovsky fight for your right to appropriate treatment is crucial.
What Should You Do if Your TMS Therapy Is Denied by Insurance?
For TMS therapy denied by insurance, having a strong legal presence in your corner is essential. Attorney Scott Glovsky will guide you through the process of submitting all necessary forms to the insurance company and can counsel you to file an internal appeal. An internal appeal asks the insurance company to take another look at its denial. If it stands behind its initial denial, Scott will advise you either to file an external appeal with a neutral third party or to take a different route. You do have options. Unfortunately, many people simply give up once their insurance company issues a denial. Many appeals are successful, so it is important to fight for your health or the health of a loved one.
What Insurance Companies Are More Likely to Deny TMS Therapy?
Although any insurance company may deny TMS therapy, some insurers are more likely to do so. The California insurance companies that may deny your TMS therapy include:
Can TMS Therapy Be Prescribed for Other Medical Issues?
In addition to major depression, migraines, OCD, and smoking cessation, TMS therapy may also be used to treat conditions like bipolar disorder, anxiety, ADHD, and even chronic pain. Increasing evidence shows that TMS can be a safe and effective treatment for chronic pain conditions that have failed to respond to other therapies, including fibromyalgia and chronic neuropathic pain.
In studies, about half of the patients that received TMS treatment for pain experienced a significant reduction in pain levels—by at least one-third or more. Pain relief usually begins within several days of treatment and can last for several months, although regular maintenance treatments can help the benefits last longer. At present, most insurers will only (grudgingly) cover TMS treatments for severe depression that have not responded to other therapies.
How Can Your Doctor Help You Get the TMS Therapy You Need?
TMS therapy denied by insurance can feel like a devastating blow. Your first step might be to speak to your doctor about the insurance denial. Your doctor may be able to write a persuasive letter that explains in detail why you need TMS therapy. The doctor will detail any other treatments that were unsuccessful, explaining why he or she believes TMS therapy will help your particular medical issue. Another route that can be helpful is a peer-to-peer call between your doctor and your insurance company.
How the Law Offices of Scott Glovsky Can Help When Your TMS Therapy is Denied by Insurance
The Law Offices of Scott Glovsky is different from other law firms for many reasons. We spend every day helping people who are being denied necessary treatment by their insurance companies. Attorney Scott Glovsky began his career defending large insurance companies, so he understands the tactics big insurance companies often use to deny treatments. This gives him a unique perspective that benefits his clients. Scott is highly respected in the legal industry, with a solid reputation among other attorneys and clients, and will never back down from a fight. At the Law Offices of Scott Glovsky, we believe in personal, caring client attention. To this end, we take very few cases, so we are able to devote a significant level of time and care to each client. If your insurance company has denied your TMS therapy—or another medical treatment—contact the Law Offices of Scott Glovsky today.