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TMS Insurance Authorization Request

Transcranial Magnetic Stimulation (TMS) Insurance Authorization Request

BrainHealth Solutions is pleased to be offering Transcranial Magnetic Stimulation (TMS), a revolutionary noninvasiveprocedure that uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of depression or anxiety.

 

TMS is a treatment for individuals who have been diagnosed with severe depression or anxiety. This is an excellent non-medication treatment option for individuals experiencing severe depression or anxiety and it has been life changing for many of our patients. Typically most insurance will cover this procedure for individuals who have not had previous success with at least two different prior medication trials. TMS has been cleared by the FDA and is recommended by the American Psychiatric Association for the treatment of major depressive disorder.

 

If you would like more information about the treatment, please contact our team.  If you already know you would like to begin TMS treatment, we can request authorization to determine if your insurance will cover this procedure and what your out of pocket costs may be.

 

Please answer the following questions and our office can determine if you may be covered for TMS treatment.  Patients can often get authorized and started with treatment within a week of request.

SECTION ONE
 

SECTION 1- PATIENT CONTACT

Would you like to go through your health insurance or pay out-of-pocket for treatment
Have you been diagnosed with Major Depressive Disorder?

Sucess! Thanks for completing Part One! Please continue to Part Two.

SECTION 2 - PATIENT HISTORY

What Psychiatric conditions (if any) have you been diagnosed with in the past?

Please list all prior psychiatric medications you have tried:
Most major insurances typically require at least 2-4 medication failures with a side effect or lack of effect at maximum dose for at least 3 months.

Add More

Please describe prior psychotherapy

Add More

Have you received evidence based outpatient psychotherapy for depression without significant improvment in symptoms?
Do you have ferromagnetic or other manetic-sestitive metal implants in your head?
Have you had TMS in the past?
Are you interested in TMS or SAINT Protocol?

Success! Thanks for completing!

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