Does Insurance Cover Ketamine Treatment? -Quick answer

Does insurance cover ketamine treatment? The answer to this question depends on the type of insurance you have and your specific coverage situation. This article will cover how ketamine works and whether or not it’s covered by insurance.

What Is Ketamine?

Ketamine is a general anesthetic, sometimes used as a horse tranquilizer. It can also be used to sedate people experiencing PTSD. Recently, researchers found that ketamine may help treat depression symptoms.

Ketamine infusions are typically given by medical professionals in doctor’s offices and clinics. However, ketamine clinics have started offering low-cost treatments via intravenous drips at affordable prices for those without health insurance.

Does Insurance Cover Ketamine Treatment

Most health insurance providers will not cover ketamine treatment. According to statistics by Medi-Cal, of all medical treatments offered by doctors and other healthcare providers, insurance companies only agree to pay for 37%. As a result, some people may find that they need to pay for their Ketamine treatment out of pocket.

Suppose you are in a position where you are considering paying for ketamine out of pocket instead of using your health insurance coverage. In that case, you must make sure you understand whether or not your health plan covers ketamine before deciding whether or not to use it.

So If Ketamine Can Help In Depression, Why Isn’t It Covered?

Some insurance companies cover ketamine treatments for chronic pain, but they don’t typically cover it as a depression treatment. Why? Because there’s no proof that it works. It seems to help some people, and even doctors will admit that they are seeing promising results with treatments using ketamine.

Still, studies haven’t been conclusive enough to convince health insurers to pay for it. Studies are ongoing, and many providers are beginning to offer payment plans based on participation in clinical trials of ketamine treatments.

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How to Determine if Your Insurance Provider covers ketamine

To determine if your insurance provider covers ketamine treatment, you’ll need to contact them directly. Here are a few things to consider before calling:
1) Ask your doctor if they offer one-time treatments or if they require a scheduled follow-up.
2) If they need it repeated, ask how many doses will be needed and how often those doses will be administered.
3) Determine whether an MRI or PET scan is needed to determine if your plan will cover it.
4) If a scan is needed, ask for clarification about any out-of-pocket expenses associated with it.

Other Programs to Help Reduce Ketamine Treatment Costs

There are government programs in place that can help subsidize costs. As part of its National Health Service (NHS), England offers Ketamine IV Therapy Treatment to those who have exhausted all other medical options and live within 60 miles of their nearest facility.

Keep in mind that their assistance is extremely limited—you’ll only be able to receive up to 4 sessions per year, and you won’t be reimbursed for anything outside of these 4 treatments.

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