If we’re not in your insurance network, that doesn’t automatically mean TMS is out of reach. You may still have benefits that help with the cost of NeuroStar TMS therapy. Our Santa Monica team can walk you through the questions to settle before you start, like out-of-network benefits, approvals your plan may need, and what you might pay.
Whether your plan reimburses out-of-network care depends on your specific policy. Check your benefits before scheduling so you understand what your insurer may pay and what you could owe.
An out-of-network provider does not have a contract with your health plan for negotiated in-network rates. Depending on your policy, you may pay more for treatment, receive partial reimbursement, or have no coverage for routine out-of-network care.
Before starting TMS, check these six details:
Does your plan cover TMS from a provider outside its network?
How much must you pay toward eligible expenses before your plan contributes?
What percentage of the plan’s allowed amount would you be responsible for?
What amount will your insurer use to calculate payment? It may be lower than the clinic’s charge.
Must your insurer approve TMS before treatment begins?
If your plan excludes the treatment or out-of-network care, could you be responsible for the full charge?
Your plan may let you see providers outside its network, depending on how it’s set up. PPO plans usually do. HMO and EPO plans generally only cover non-emergency care from in-network providers, so it’s worth checking which one you have.
Which types of plans should I check?
Often include out-of-network benefits, although your deductible, coinsurance, and reimbursement limits may differ from in-network care.
Generally limit routine care to network providers. Out-of-network coverage may be restricted to specific circumstances.
Generally cover care within the network, apart from applicable exceptions such as emergencies.
May allow out-of-network care under the plan’s referral and cost-sharing rules.
These are general plan characteristics, not a determination of your individual benefits. Your policy may have different terms.
With out-of-network benefits, you may be able to file a claim for TMS and get part of the cost reimbursed. The steps depend on your insurer and our payment setup, so confirm both before you begin.
What steps should I take?
Call your insurer and ask whether outpatient TMS is covered when you go out of network, and how they handle reimbursement.
Ask whether your plan requires prior authorization or medical records before your first session.
Check with California TMS Clinics about when payment is due and whether you pay before treatment starts.
Ask what receipts or records we can give you. Some insurers want an itemized receipt (called a superbill) or their own claim form.
Follow your insurer’s instructions and filing deadline, using its online portal or the required form.
Save receipts, authorization decisions, submitted claims, and your insurer’s explanation of benefits.
Insurance terminology can be difficult to interpret when you are also navigating depression treatment. California TMS Clinics can help you identify the questions to ask about your plan, potential costs, and documentation before you begin.
California TMS Clinics offers NeuroStar TMS therapy in Santa Monica, with psychiatric oversight and support to help patients understand their treatment and insurance questions.
Dr. Torey Troggio oversees TMS treatment at the clinic. Your provider will assess whether TMS may be appropriate for your clinical circumstances.
Our team can help you identify the questions to ask about out-of-network benefits, prior authorization, claim documentation, and potential out-of-pocket expenses.
A typical NeuroStar session lasts around 20 minutes, although your treatment plan and schedule will depend on your individual clinical needs.
It simply means a provider doesn’t have a contract with your insurance company. Your plan may pay less for their services, or in some cases nothing at all, depending on your benefits. That’s why it’s worth checking your plan before you book.
Sometimes, yes. PPO and POS plans often include out-of-network benefits, while HMO and EPO plans usually don’t. Not sure which one you have? We’ll check your plan first, so you know where you stand before you commit to anything.
We’re in network with several insurance companies, but that can change from plan to plan. Even two people with the same insurer can have different coverage. Call us at 310-857-4946, and we’ll help you work out what to check with your insurer before you start treatment.
It depends on how our clinic handles payment and on your insurance plan. Before you book, it helps to ask three things: when payment is due, whether we send claims to your insurer for you, and whether you’ll need to file for reimbursement yourself.
A superbill is an itemized document containing information an insurer may need to review an out-of-network claim. Ask California TMS Clinics which billing documents it provides, and check your insurer’s requirements before treatment.
A superbill is an itemized document containing information an insurer may need to review an out-of-network claim. Ask California TMS Clinics which billing documents it provides, and check your insurer’s requirements before treatment.
It depends on your plan. Your deductible, your coinsurance, the amount your insurer allows for the service, and any limits on your coverage all affect what you get back. Our team can help you know what to ask, but only your insurer can confirm how it calculates reimbursement, and any estimate isn’t a guarantee of payment.
Often yes. Many plans require approval for TMS regardless of network status, so ask before booking.
Ask your plan about a network gap exception. In California, plans must offer timely access to care, and you may be able to get out-of-network care at an in-network rate.
One short conversation can give you real answers. Contact our Santa Monica team, tell us about your plan, and we'll explain where you stand and what comes next.
Coverage varies by plan and isn't guaranteed. Please confirm your benefits with your insurer.
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