January 9, 2023

Is Ketamine Therapy Covered By Insurance?

There’s no disputing the therapeutic benefits of ketamine when at home psychedelic therapy is done under the supervision of trained professionals. The largest ketamine therapy study conducted to date recently proved that doing a ketamine treatment at home is safe and highly effective. What’s more, the study found that across a large, diverse group of patients there were minimal side effects.

These studies have been rigorously scrutinized. So much so, ketamine studies have been double-blind and randomized with active-placebo controls. Even with the highest of testing standards, ketamine continues to show efficacy in treating depression, anxiety and other mental health disorders. 

The amazing results that have been seen, results that can be life-saving, are part of the reason why ketamine therapy is legal. Its therapeutic properties are undeniable. But could your insurance company still deny coverage for ketamine treatments?  

Health Insurance and Ketamine Therapy

With so many Americans struggling with mental health disorders, it’s shocking how long it took for insurance providers to cover any kind of mental health therapy at all. Even with regulations that ensure any health insurance plan that’s bought on the Marketplace must provide mental health coverage, that doesn’t guarantee all treatments are covered. And there could still be a co-pay even if coverage is provided.

Currently, insurance coverage for ketamine therapy, whether it be in a clinic or at home, varies by provider and by plan. Health insurance providers state a few different reasons for why at home ketamine therapy isn’t covered, despite showing efficacy: 

  • Ketamine therapies for some mental health conditions is considered “off-label.” However, because ketamine is FDA-approved it can legally be used for off-label purposes. It’s legal for licensed physicians to prescribe and ketamine has been safely used off-label for decades.
  • But even FDA approval for a specific medication won’t necessarily be enough. Case in point, the FDA-approved ketamine nasal spray Spravato isn’t even covered by many health insurers. 
  • Coverage can even come down to how the ketamine treatment is labeled by the physician. 
  • Many providers say that ketamine therapy is experimental and therefore they don’t have to provide coverage for treatments. 

The last reason is getting harder and harder for health insurance companies to make. As more studies show ketamine therapy works and it works better than many other medications, this reasoning just won’t hold up. It’s especially frustrating for patients that can get full coverage for antidepressants that don’t work and have more side effects.

For now, if your health insurance plan doesn’t explicitly cover ketamine treatments you still may be able to get some help paying the costs. You can request a partial reimbursement from your health insurance provider. It may take some work, but it’s one way to possibly lower the out-of-pocket expenses. 

Why Health Insurance Cover is Vital for Improving Access to Ketamine Therapy 

It’s well known that cost is a major barrier for access to healthcare. Those who can afford the highest level of PPO health insurance plans with a reasonable deductible can easily access medical professionals and their insurance covers most treatments with minimal out-of-pocket expenses. But if you are on a basic HMO, have Medicaid or rely on Medicare not everything is at your disposal. That’s especially true if treatments aren’t covered by health insurance at all.

That’s the sound argument that has been made in response to insurance providers not providing coverage for ketamine therapy. Insurance coverage means more people have access to treatments that can dramatically improve their health, quality of life and relationships with others. And being able to take a ketamine treatment at home means almost anyone with health coverage would be able to utilize the therapy. 

Our Austin ketamine specialists can help patients that live miles away thanks to at home psychedelic therapy. When you’re able to administer ketamine therapy at home there’s less stigma and more convenience since you don’t have to spend hours at a clinic. You may even have a more enlightening experience in the relaxation and comfort of your own home. 

Take the confidential online assessment to find out if you’re eligible for at home psychedelic therapy.