Is Ketamine Infusion Covered By Insurance?

Ketamine was approved by the FDA as an anesthetic in 1970. Ketamine Infusion Therapy for the treatment of mental health conditions and chronic pain conditions is considered off-label use. While off-label prescribing is a common practice (33% of psychiatric medications are prescribed off-label in the United States), this can create limitations for insurance coverage.

The FDA approval process is expensive and time-consuming, so many medications that are already approved for one use, do not go through the approval process again for additional uses. As a result, health insurance companies can deny coverage for ketamine treatment for the symptoms of depression, other mood disorders, and chronic pain despite their efficacy and in many cases, the ability to save insurers money that they’re already spending on less effective treatments. Patients should be aware that insurance reimbursement for a ketamine infusion can be inconsistent and partial, if at all. However, more insurers (especially those offering PPO plans) are reimbursing patients more consistently for a portion of the cost of treatment. Ketamine Clinics Los Angeles provides patients with statements with the necessary billing codes needed to submit a claim for reimbursement. 

How to Get Insurance Coverage for Ketamine Treatment

Here’s what you can do to increase your chances of getting insurance coverage for your Ketamine Treatments:

  1. Give us a call. Your care team at KCLA will gladly advise you on issues related to payment, financing, and the possibility of securing ketamine insurance coverage.
  2. Review statement details. Ketamine Clinics Los Angeles has put together highly effective billing statements in order to give patients the best chance of reimbursement. 

Call your insurance provider. Individual insurance plans vary widely and no one company has a policy that applies to all plans. Contact your insurance provider and discuss the possibility of ketamine Infusion insurance coverage to help offset the cost of treatment.

Why Isn’t Ketamine Treatment Covered?

There are a number of reasons why it’s difficult to get infusions of ketamine covered by insurance. Many pharmaceutical companies do not want to see ketamine used therapeutically because it could reduce the sales of traditional antidepressants, which are highly profitable for them despite being less effective for patients. Insurance companies typically resist accepting ketamine as a credible treatment for depression, other mood disorders, and chronic pain because it is an off-label use, among other reasons.  

Researchers have proven Ketamine Infusion Therapy’s efficacy to exceed that of conventional antidepressants in many cases. Fortunately, there is an increasing awareness developing in the medical and psychiatric communities where ketamine therapy is acknowledged as a crucial procedure that needs to be “mainstream.” The need for immediate solutions that provide real results to the depression and suicide crisis is urgent.  With the recent FDA approval of Spravato, esketamine (a component of ketamine), for depression there is an increased chance that insurers may consider including coverage for other ketamine treatments, such as Ketamine Infusions.

Contact Ketamine Clinics of LA Today

Ketamine Clinics of Los Angeles is led by compassionate and experienced ketamine therapy expert Dr. Steven L. Mandel in a state-of-the-art facility. We have pioneered this treatment in a safe, relaxing, and professional environment. The KCLA team provides ketamine infusion treatments to patients in Los Angeles, Westchester, Culver City, Beverly Hills, Venice, Marina del Rey, Santa Monica, the South Bay, Playa del Rey, Playa Vista, other parts of California, various states throughout the U.S. and abroad. Contact us to learn more and to schedule your free phone consultation today.

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