Is Ketamine Therapy Covered by Insurance? What You Need to Know

It has gained particular prominence in the past few years as an adjunct therapy option to rapidly relieve the symptoms of various mental health disorders. With growing research backing its effectiveness, a greater number of patients are considering this treatment option. Despite all this, one crucial issue still persists. What is the coverage for ketamine therapy under an insurance policy?

What Is Ketamine Therapy?

As a uniquely specialized anesthetic, which was deemed to be safer than most previously used anesthetics, ketamine was developed in 1962. The FDA approved its use in 1970 for a myriad of medical purposes. Since then, it has been used for both human medicine and veterinary medicine for the purposes of inducing loss of consciousness, pain relief, and temporary amnesia.

Medical and Veterinary Applications

It is essential to note that Ketamine was one of the most important drugs in battlefield medicine during the Vietnam War. Initially, it is still widely used today as an anesthetic for human and animal surgeries. Ketamine is also useful for controlled treatment of acute pain and is often used to assist in preparing patients for surgical procedures.

Ketamine for Mental Health Treatment

Interest in ketamine’s potential for treating mental health conditions dates back to the 1960s and 1970s. However, due to negative side effects, and its increasing use as a recreational drug, further research on the drug was stalled for decades.

Research began as early as the 2000s to identify how quickly ketamine relieved symptoms of depression. This led to the Spravato (esketamine) nasal spray being approved by the FDA in 2019. Spravato is targeted towards patients who have depression but do not respond to other treatment options. Although Spravato is the only FDA approved treatment for ketamine, many physicians prescribe it off-label for other diagnosis, including:

• Anxiety
• Bipolar disorders
• Obsessive-compulsive disorder (OCD)
• Post-traumatic stress disorder (PTSD)
• Addictions

The most notable characteristic of ketamine therapy that sets it apart from other conventional depression treatments is its speed. While most antidepressants can take weeks to show any effect on the patient, symptom relief is achievable in a matter of hours or days with ketamine.

How Much Does Insurance Pay For Ketamine Therapy?

Two main factors play an important role in determining how much coverage there is for ketamine therapy: the medical insurance plan you are enrolled in and what type of ketamine therapy is being performed.

Spravato (Esketamine) Nasal Sprays

• It is administered in a clinic under healthcare professional guidance which ensures it is administered correctly.
• Most insurances, including Medicare Part B, cover it.
• They all differ in coverage limitations like co-pay amounts or requiring authorization beforehand.

Ketamine Infusion Therapy (IV/IM)

• This is where the ketamine is injected into the patient’s arm via IV or IM in a clinical setting.
• Because this application of ketamine is off-label, it will rarely be reimbursed by an insurer.

Oral Ketamine Therapy

• Some clinicians provide a tablet of ketamine that can be self-administered at home.
• While convenient, there is no professional supervision involved, and it is usually not reimbursed by an insurer.

Reviewing Your Insurance Plan

Should you decide to undergo treatment with Spravato, most likely your plan will include reimbursement. Still, it is prudent to check the policy and confirm:

• Co-payment and coinsurance
• Pre-authorization needed
• Restrictions based on provider network

It is unlikely that any reimbursement will be provided for the infusion therapy or oral ketamine. The surest way to know what your benefits are is by calling your insurer.

Ketamine Therapy Options Available in New Jersey

At Neuroplasticity MD, we aim to help those suffering from anxiety, depression, and other disorders through innovative, evidence-based mental health treatments, including Spravato therapy.

Our kind staff gives individualized care to each patient in an outpatient facility so that all patients feel fully cared for.

For more information regarding ketamine therapy in New Jersey or to get a free consultation, 🌐 Visit Our Website & call us, 📞 + 1 201 500 9728 today |