Hey, I’ve been getting ketamine infusions for over a year now. My doctor’s office doesn’t take insurance for it, but I’ve been sending my bills to my insurance company anyway. Here’s what happened:
Most likely, they’ll say it’s not covered, so you won’t get any money back. But it can still count toward how much you have to pay out of your own pocket for medical stuff in a year. That might help with other costs like copays and prescriptions, especially if you see doctors who aren’t in your insurance network.
For me, my insurance (which is pretty good, it’s called a PPO plan and covers a lot) has paid for some of my treatments, but not all. I’m not sure why. They also said they’re looking into whether they should cover it more since a similar treatment called nasal esketamine got approved.
But getting the insurance to pay took a lot of time and effort. I had to call them many times and it took hours. And I could only start dealing with it once I started feeling better.
So, don’t expect to get your money back easily. But it’s worth a shot.
Has anyone else tried getting insurance to cover ketamine infusions? What was your experience like?
Your experience sheds light on the difficulties and possible upsides of trying to get insurance to cover ketamine infusions. Despite expecting no reimbursement, you found that your persistent efforts led to partial coverage under your PPO plan, highlighting insurance variability and the evolving nature of treatment approvals. This process required significant time and improved health to manage effectively. You’ve also noted that, even if direct reimbursement isn’t received, these costs can contribute to annual deductibles, potentially reducing other healthcare expenses. This suggests that while challenging, pursuing insurance coverage for treatments like ketamine infusions can be beneficial, inviting others to share their own experiences with insurance for emerging treatments.
The best approach is to have an open conversation with your insurance provider to understand their coverage policies and determine the most appropriate path forward.
Your health and well-being should be the top priority here