When it comes to whether ketamine is covered by insurance, it’s tricky. Even though some forms of ketamine have FDA approval for certain conditions, insurance companies don’t always include them in their coverage.

You might have experienced this yourself when your doctor prescribes a medication, but your insurance says it won’t pay for it and offers you something else instead. The insurance company makes this decision based on factors like cost and how well they think the treatment works.

Why do Major Insurance Companies refuse to Cover Ketamine Infusion Therapy?

Insurance companies often don’t cover ketamine treatments because the original form of the drug is no longer very profitable for pharmaceutical companies since its patent has expired. Although the FDA originally approved ketamine for anesthesia and pain relief, doctors can still use it for other purposes, even if it’s not officially approved for those uses.

How Much Do Ketamine Infusions Cost?

Before deciding on ketamine infusions, it’s important to know how much they cost. The price can change depending on where you go, how well-known the clinic is, and how many sessions you need.

Generally, one session can be between $400 and $800, and you might need several sessions for the whole treatment. Even though it can be expensive, the benefits of ketamine infusions for mental health can be significant.

Some people feel their symptoms improve enough to make the cost worth it. To make it more affordable, you can also look into payment plans or financing options with the clinic.

Insurance Coverage Affecting Factors for Ketamine Infusions

Whether your insurance covers ketamine infusions depends on several factors. Firstly, it matters what you are getting ketamine for. Some insurance plans will pay for it if it’s for certain mental health problems, but not for others.

Another big deal is what your doctor writes down about why you need ketamine. Insurance companies usually want a lot of information, like your medical records and treatment plan. If your doctor gives them all that, it’s more likely they will cover your ketamine infusions.

Ways to Get Reimbursement for Your Ketamine Infusions

We know there are certain scenarios in which the insurance companies might be willing to reimburse you for your ketamine treatment. Following are some ways you can convince them to do so:

  • Maintain Consistency
    Don’t give up if you get different answers from different people at the insurance company. Keep notifying them how ketamine has helped you and others.
  • Point Out the Gap
    Insurance companies might not have a plan for covering ketamine, so remind them it’s a missing part of their coverage. You can suggest they treat ketamine infusions like they do with out-of-network providers.
  • Protect Your Privacy
    Ensure the clinic keeps your information private and follows HIPAA rules to keep your records and treatment details confidential.

Key Takeaway

As medical professionals discover more conditions that ketamine can help with. You can expect more research to change the tentative answer to” Is ketamine covered by insurance?” into the affirmative.

Soon, the highly effective ketamine infusions will be less burdensome due to insurance coverage. Visit Dr. Raza Jafri at Balanced Ketamine or call us at (913) 871-9888 for more details on the procedure.

Skip to content