INSURANCE

In-Network Coverage with Aetna and BCBS

MPH proudly partners with Aetna , Blue Cross Blue Shield (BCBS) PPO and Blue Care Network of Michigan (BCN), and Traditional, making strides towards broader insurance acceptance for ketamine therapy. While ketamine treatment is pioneering in mental health and pain management fields, it is still classified as experimental by many insurance providers. This classification affects the scope of coverage available for ketamine therapy, including ketamine infusions.

For patients covered under Aetna or BCBS, our billing department can directly bill your insurance for office visits and therapy sessions. However, it’s important to note that ketamine administration itself is not typically a covered benefit under these plans. This distinction can significantly reduce the overall cost of infusions, often by as much as half, making treatment more accessible to those in need.

Understanding Your Coverage

To assist you in navigating your insurance benefits, MPH has developed detailed documentation outlining what aspects of ketamine therapy are likely to be covered. Our intake coordinators are readily available to address your questions, providing personalized support to ensure you have a clear understanding of your insurance policy’s specifics.

Out-of-Network Coverage Opportunities

For patients without Aetna or BCBS coverage but who have out-of-network benefits, there’s potential for reimbursement for a portion of your ketamine therapy costs. It’s essential to understand the terms of your insurance plan, as reimbursement rates and covered services can vary widely. At the time of your treatment, payment can be made via cash, check, or credit card. Additionally, MPH will furnish a Superbill upon request, which you can submit to your insurance provider for potential reimbursement.

Maximizing Your Insurance Benefits

To maximize your insurance benefits for ketamine therapy, consider the following steps:

1. Contact Your Insurance Provider: Begin by contacting your insurance company to inquire specifically about coverage for ketamine therapy.
2. Review Your Policy: Carefully review your insurance policy’s details, paying close attention to any provisions for experimental treatments, out-of-network benefits, and mental health services.
3. Documentation: Keep detailed records of all communications with your insurance provider, as well as any receipts and medical documents related to your treatment.
4. Appeal if Necessary: If your claim is denied, don’t hesitate to appeal. Often, persistence and providing additional documentation can result in a favorable outcome.

At MPH, our goal is to make ketamine therapy accessible to those who can benefit from it. By partnering with insurance providers like Aetna and BCBS, offering clear guidance on insurance coverage, and providing financing options through Care Credit, we strive to alleviate the financial burden of treatment. If you have further questions about insurance coverage for ketamine therapy, our dedicated team is here to assist you every step of the way.

Understanding your insurance coverage for ketamine therapy doesn’t have to be a daunting task. With the right information and support, you can navigate your benefits confidently and make informed decisions about your treatment options.