Is ketamine covered by insurance? How to get your treatment covered (Updated May 2022)

Updated 5/2/2022

As ketamine therapy becomes a popular treatment option for both physical and mental conditions, the question of insurance coverage remains difficult to answer. While we cannot control what portion of your treatment will be covered by insurance, we can help you work with your insurance company to get the most out of your plan. By advocating for our patients and working directly with your insurance provider, we aim to make your treatment process as straightforward and affordable as possible.

The Insurance Challenge Facing Ketamine Providers

And how KWC is stepping up

While the value of ketamine in medicine is well-established, many insurance companies remain hesitant to provide treatment reimbursements. Providers seldom take a consistent stance on ketamine coverage, meaning decisions can vary on a case-by-case basis. As a result of these hurdles, many ketamine clinics have elected to limit their services or take cash-only payments. 

Ketamine Wellness Centers tackles the insurance issue head-on by working with your insurance company and providing the support you need throughout this process. Even if your insurance plan is not part of our group of in-network carriers, there are steps you can take to fight for reimbursement. 

The State of Coverage for Ketamine Therapy

In general, ketamine treatment for physical pain is easier to reimburse than treatment for mental wellness. While coverage is not guaranteed, a valid medical pain diagnosis such as fibromyalgia, migraines, or Complex Regional Pain Syndrome can help your eligibility. For many patients, winning insurance coverage for neuropathic pain treatments can be a realistic and achievable goal.

In rare cases, Medicare and Medicaid may cover chronic pain patients whose medical coverage falls under the Americans with Disabilities Act. However, because of the lengthy process and difficulty of receiving reimbursements through this avenue, we recommend that Medicare beneficiaries seek coverage through a secondary insurance company.

More information about insurance coverage for chronic pain patients

Unfortunately, most insurance companies remain hesitant to cover ketamine treatments for mental wellness. New options for treatment have expanded the availability of ketamine therapy, but the issue of coverage remains an uphill battle.

Until 2019, infusions and injections were the only option available for patients seeking ketamine treatment. This changed when the nasal spray Spravato (chemically known as S-ketamine) was approved by the FDA for treatment-resistant depression. While the approval of Spravato does not guarantee coverage, it does increase the likelihood of securing it. In certain cases, medication like Spravato may be available at a reduced cost through your insurance. In particular, patients covered through the Veterans Administration have recently been successful in having treatments reimbursed.

More information about insurance coverage for mental wellness

We remain optimistic that as patients and professionals continue to see the benefits of ketamine therapy, insurance providers will step up to meet the rising demand. Until then, there are a number of ways our team can help.

Understanding Your Options

Ketamine Wellness Centers is committed to pushing for broader insurance coverage and advocating for our patients. Whether you are seeking treatment for a physical or mental condition, our team is here to help you find the lowest possible treatment cost.

Even in cases where ketamine infusion is not covered through insurance, other aspects of the bill may be reimbursed. The price tag on ketamine therapy also includes medical monitoring, professional supervision, and equipment used during the procedure, all of which are often covered by insurance. In many cases patients do not pay the full cost of treatment, even if insurance does not cover the infusion itself. 

Because navigating insurance can be difficult, KWC is available to work with you directly through this process. Our insurance specialists can help you find out what coverage you are eligible for, receive prior authorization from your insurance company, and provide a superbill for reimbursement claims.

Despite the difficulties associated with insurance, many of our patients who have out-of-network plans have successfully submitted for partial or complete reimbursement for their treatments. If the cost of ketamine therapy is a barrier to your treatment, know that our team may be able to work with your insurance company to help you receive care.

To connect with an insurance specialist for more information, you can reach us at 855-KET-WELL (855-538-9355) or insurance@ketaminewellnesscenters.com.

Ketamine Wellness Centers

Ketamine Wellness Center’s mission is to provide personalized, compassionate, high-quality care for people suffering from afflictions where Ketamine infusions have proven a successful treatment option (Depression, Chronic Pain, PTSD, OCD, Suicidality) while actively researching Ketamine’s efficacy to treat additional conditions. There is hope. There is help.

PHONE:
855-KET-WELL (1-855-538-9355)

FAX:
844-KET-WELL (1-844-538-9355)

EMAIL:
info@ketaminewellnesscenters.com

CLINIC LOCATIONS:

Chicago, Illinois
603 E Diehl Rd, Suite #139 Naperville, IL 60563

Dallas-Fort Worth, Texas
6144 Precinct Line Road, Suite 100 Hurst, TX 76054

Denver, Colorado
7261 S Broadway, Suite 10-L Littleton, CO 80122

Houston, Texas
12807 Haynes Rd. Building A, Unit 1 Houston, TX 77066

Jacksonville, Florida
3753-2 Cardinal Point Drive Jacksonville, FL 32257

Las Vegas, Nevada
7375 S. Pecos Rd. Suite 102 Las Vegas, NV 89120

Minneapolis-St Paul, Minnesota
11995 County Road 11, Suite 220 Burnsville, MN 55337

Mesa-Gilbert, Arizona
2451 E. Baseline Rd, Suite 300 Gilbert, AZ 85234

Phoenix, Arizona
3724 N 3rd. St. Suite 201 Phoenix, AZ 85012

Reno, Nevada
1895 Plumas St. #6 Reno, NV 89509

Salt Lake City, Utah
6087 S. Redwood Road STE. B Taylorsville, UT

Seattle, Washington
34709 9th Ave S. Suite-B 200 Federal Way, WA 98003

Tucson, Arizona
3130 N Swan Rd. Tucson, AZ 85712

Related Posts

April Newsletter

CEO Update | April 2022

Message from the CEO The treatment model at Ketamine Wellness Centers can be viewed as a three-legged stool: ketamine and other contemporary medicine, mental wellness

Read More »