Thankfully, insurance companies are starting to understand the cost-effectiveness of TMS when looking at the big picture of a member who continues to trial, unsuccessfully, one antidepressant after another. While the depression symptoms worsen, other complications, such as acquiring a substance use disorder, can compound the medical costs of untreated Major Depressive Disorder (MDD). Considering the collateral effects of untreated MDD, providers are now offering coverage for TMS therapy when certain criteria are met. These criteria include:
- A qualifying medical diagnosis (treatment is medically necessary)
- Failure of patient to respond to usual antidepressant medication
- Patient had received some psychotherapy
Although these are the general criteria required for authorizing TMS benefits, each insurance carrier, as well as the various healthcare plans, can vary with regard to the specific qualifying criteria.