Ketamine

Is Ketamine Therapy Covered By Insurance?

By April 4, 2022 No Comments

Is Ketamine Therapy Covered By Insurance For so many individuals, making the decision to undergo ketamine therapy is a pivotal step towards reclaiming health and happiness. If you’re interested in discovering how ketamine therapy may be able to help you, it’s likely that you have quite a few questions about how ketamine therapy works and what to expect from the process. 

And like most prospective patients, you probably want to know: Is ketamine therapy covered by insurance?

Does Insurance Cover Ketamine Therapy?

It depends.

As much as we would like to be able to answer this question with a straightforward “yes,” it is unfortunately not yet that simple. Ultimately, there are a few factors that affect the potential of insurance coverage for ketamine therapy:

  • Which insurance provider/plan do you have
  • Where you are receiving ketamine therapy (i.e., therapy center, state, etc.)
  • Which form of ketamine therapy you are receiving

Like so many pioneering medical treatments, ketamine therapy often falls within a “gray area” when it comes to insurance coverage. 

Despite being backed by nearly two decades of scientific research, ketamine therapy for mental health conditions and chronic pain is still considered an “off-label” treatment by the FDA. As a result, many insurance providers have yet to officially extend their coverage to include ketamine therapies.

What does “off-label” mean?

First and foremost, it is essential to know that ketamine is approved by the FDA

The FDA, or Food & Drug Administration, is the federal agency in charge of approving the legalization of various prescription drugs in the U.S. For a prescription drug to earn FDA approval, the following information must be provided to the agency:

  • Evidence that the specific drug is effective and safe
  • The conditions that the drug can be used to treat
  • The safe dosage amount(s)
  • Details about how the drug has been tested 

Once a prescription drug is FDA-approved, doctors are permitted to prescribe it to their patients.

However, FDA approval only applies to the very specific uses/purposes outlined in the information submitted to the agency. Doctors are still allowed to prescribe the drug for other uses, a practice that is extremely common. 

When a medication is doctor-prescribed for a purpose that is not officially listed in the drug’s FDA approval, it is referred to as “off-label use.”

Of course, doctors are not simply prescribing medications for off-label use at random. Rather, doctors only prescribe a medication for off-label use when there is ample scientific evidence that a specific drug is a safe and effective treatment option for a patient’s condition – the only “missing piece” is the official FDA approval, a process that can often take far longer than patients can afford to wait.

Is Ketamine Therapy Covered by Insurance as an Off-Label Treatment?

There are many benefits to the off-label use of various drugs, including ketamine. Unfortunately, the one disadvantage to the off-label use of ketamine for mental health and chronic pain conditions is that it is not necessarily covered by all insurance carriers.

But at the Klarisana ketamine therapy centers in Texas, Colorado, and New Mexico, we have sought out every possible avenue to make ketamine treatment as affordable for patients as possible – and we will continue to do so. This means that our approach incorporates cost-effective administration methods (that are no less effective) and that we have worked tirelessly to establish relationships with multiple governments and private insurance companies.

Klarisana is one of the only ketamine centers that offer treatment options that are covered by a number of insurance providers. 

Many of our patients do not pay any out-of-pocket costs, with the exception of any deductibles or co-pays that are required by law/their policy. 

Insurance plans currently accepted by our ketamine centers include Colorado and Texas Medicaid, as well as coverage provided by major companies such as United Healthcare, Tricare, Cigna, and Blue Cross Blue Shield. 

Find Out if Your Insurance Provider Covers Ketamine Therapy for Your Condition Now

At Klarisana, we are committed to doing everything possible to make ketamine therapy accessible for patients in need. Together, we will determine if your insurance coverage includes ketamine therapy, what your total expenses may be, and how to pay for ketamine therapy in a way that suits your specific situation. We also offer in-house payment plans and financing (through Healthcare Finance Direct), and you can rest assured that we will help you navigate your options.

For more information about how to get ketamine therapy covered by insurance, as well as your options for paying for ketamine therapy, contact Klarisana today.

 

Image Source:  Maria Vonotna / Getty Images

Carl Bonnett

Carl Bonnett

Dr. Carl J. Bonnett is the founder and Medical Director of Klarisana.