Insurance & access

What it costs and how coverage works — explained plainly, before you commit.

Interventional psychiatry shouldn't come with billing surprises. This page explains what prior authorization actually asks for, what we need from you to get it approved, and what happens if a plan says no.

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Medically reviewed by C. Britt Beasley, MD · Last reviewed June 10, 2026

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One distinction explains most of it

Coverage for these treatments turns mostly on a single question: is the treatment FDA-approved or FDA-cleared for your condition?

Deep TMS and Spravato are. That is why they generally have an insurance pathway — and also why they come with prior authorization, since plans that cover a treatment want documentation before approving a course of it. IV ketamine is not approved for depression, which is why it is generally self-pay.

Everything below follows from that. It is worth understanding before you compare options, because the cheapest treatment on paper is not always the one you can actually complete.

By treatment

Where each one stands

Deep TMS

Usually covered, with prior authorization

Deep TMS is covered by many plans for treatment-resistant depression, and coverage for OCD has been broadening since the H7 coil's FDA clearance — though OCD coverage remains more variable than depression coverage, and is worth verifying specifically rather than assuming it follows the depression policy.

Nearly every plan requires prior authorization before a course begins. That is not a formality: it is where the documentation below matters, and it is the step that determines whether you start in two weeks or two months.

Learn about Deep TMS

Spravato (esketamine)

Often covered, via specialty pharmacy

Spravato is dispensed through a specialty-pharmacy model rather than billed like an ordinary in-office medication, which makes its path different from everything else here. We use the manufacturer's Spravato With Me platform to coordinate benefits verification and access.

One wrinkle worth knowing: the FDA approved Spravato as a monotherapy for treatment-resistant depression in January 2025, meaning it no longer has to be paired with an oral antidepressant for that indication. Plan policies do not always move as fast as labels do, so if monotherapy is what you and Dr. Beasley are considering, that specific point is worth verifying with your plan rather than assuming.

Because Spravato is governed by a restricted safety program, we do not publish esketamine pricing here. We review your specific coverage with you directly.

Learn about Spravato

IV ketamine

Typically self-pay — off-label

Ketamine is FDA-approved as an anesthetic, not as an antidepressant, so its use for depression is off-label. Off-label use is generally not covered, and infusions are typically self-pay.

That is a real consideration rather than a footnote. A treatment you can only afford for six weeks is not better than a covered treatment you can sustain for a year — and which of those you are choosing between is exactly the kind of thing to raise at the consult.

Learn about IV ketamine

General psychiatry & medication management

In-network for many commercial plans

For outpatient psychiatry and medication management we work with a range of plans, including coverage facilitated through Headway, which streamlines in-network access for many commercial insurers. Cash-pay is also available.

Coverage relationships change, so confirm with the office which specific plans and networks are currently accepted rather than relying on a webpage for that particular answer.

MAT (medication-assisted treatment)

Widely covered; confidential either way

Coverage for buprenorphine and Sublocade varies by plan, though many commercial and public plans cover MAT for opioid use disorder. Where coverage is limited we will discuss practical options rather than leaving you to work it out alone.

Your participation is confidential under federal law — substance use records carry protection under 42 CFR Part 2 beyond ordinary HIPAA privacy, including limits on disclosure to insurers.

Learn about MAT

Prior authorization

What plans are actually asking

Criteria vary by plan and change over time, so treat this as the shape of the question rather than any particular insurer's policy — we verify your plan's actual requirements before you start. But across plans, a prior authorization for Deep TMS or Spravato tends to ask the same families of question:

A confirmed diagnosis. Major depressive disorder, or OCD for H7 treatment — documented, and usually with a standardized severity measure rather than an impression.
Adequate prior medication trials. Typically two or more antidepressants in the current episode, each at an adequate dose for an adequate duration. This is the criterion that trips people up, and it is covered in the questions below.
A psychotherapy trial. Many plans want to see that therapy has been tried alongside medication, or a documented reason it was not appropriate or available.
No disqualifying contraindications. For TMS, chiefly ferromagnetic material in or near the head and seizure history. For Spravato, certain cardiovascular and aneurysm histories.
Clinical rationale from the physician. A letter of medical necessity: why this treatment, for this patient, now. Dr. Beasley writes it himself rather than delegating it to a template.

What we need from you

The authorization moves at the speed of its weakest piece of documentation, and that piece is almost always medication history. Bring what you can:

— Names of antidepressants you have tried, even approximately
— Roughly when, and roughly how long you stayed on each
— Why you stopped: no benefit, side effects, cost, or something else
— Any therapy you have had, and with whom
— Your insurance card, and the member portal login if you have it
— Prior records, if you have them or can tell us where they are

Nobody expects a perfect list. "Two SSRIs around 2023, one made me nauseated" is genuinely useful; we can often reconstruct the rest from pharmacy records with your permission.

Questions worth asking your plan

You can call the member-services number on your card and ask these directly. It takes about ten minutes and tells you more than any webpage can:

— Is transcranial magnetic stimulation a covered benefit on my plan? For OCD as well as depression?
— Is esketamine (Spravato) covered, and under my medical or pharmacy benefit?
— How many antidepressant trials does the policy require, and over what duration?
— Do I need a referral to see a psychiatrist?
— What is my deductible, and how much of it have I met this year?
— What is my per-session copay or coinsurance once authorized?

That last pair matters more than people expect for TMS: a course runs many sessions, so a per-session copay is multiplied rather than paid once.

If the answer is no

A denial is a step, not a verdict

First denials happen, and they are more often about documentation than about clinical judgment — a medication trial that was not recorded at an adequate duration, a severity measure the reviewer did not see, a criterion answered in a sentence when the policy wanted a paragraph. Those are fixable.

Plans have an internal appeal process, and a peer-to-peer review — where Dr. Beasley speaks directly with the plan's reviewing physician — is often the step that resolves it. If internal appeals are exhausted, Virginia offers an external review through the State Corporation Commission's Bureau of Insurance, where an independent reviewer outside the plan makes the call.

You are not doing this alone. Dr. Beasley writes the letter of medical necessity, takes the peer-to-peer call, and pursues the appeal with you.

Common questions

Straight answers about coverage

What does "failed two antidepressants" actually mean?

It usually means two medications from the current depressive episode, each taken at an adequate dose for an adequate duration — commonly six to eight weeks — without adequate response. Two prescriptions you stopped after a week because of side effects often will not count, which surprises people. Bring what you remember: the names, roughly when, roughly how long, and why you stopped. Incomplete history is the single most common reason an authorization stalls.

Is IV ketamine covered by insurance?

Generally no. Ketamine is FDA-approved as an anesthetic, so using it for depression is off-label, and off-label use is usually not covered — infusions are typically self-pay. Spravato is the ketamine-family option with an insurance pathway, because it carries an FDA approval for treatment-resistant depression. If cost is a deciding factor, say so at the consult: it legitimately changes which treatment is the better recommendation.

Do I need a referral?

Not for this practice — you can call directly. Some plans require a referral or a primary-care gatekeeper for specialist visits, which is a separate question from whether we require one. That is worth checking with your plan, and it is on the list of questions below.

What if my insurance denies the authorization?

A first denial is not the end, and it is more common than most people expect. Plans have an internal appeal process, and Virginia also provides an external review through the State Corporation Commission's Bureau of Insurance once internal appeals are exhausted. Denials frequently turn on missing documentation rather than a judgment that the treatment is wrong for you — which is a fixable problem. Dr. Beasley writes the letter of medical necessity and handles the appeal with you.

Can I use insurance for the consult and self-pay for treatment?

Often yes, and it is a reasonable way to start. The consult and the treatment are billed separately, so a covered evaluation can tell you whether a self-pay treatment is even worth considering before you spend anything on it.

Will you tell me the cost before I start?

Yes. We verify your benefits before a course begins, not after — you should not be weeks into treatment before finding out where you stand. Ask the office for current self-pay structures for anything insurance does not cover.

The simple version

Tell us your insurer when you request an appointment. We verify coverage and explain the path for whichever treatment fits you — before you commit. If something is not covered, you will hear it from us plainly and early, not on a bill.

Compare Deep TMS, Spravato, and IV ketamine

This page describes coverage structures generally and is not a guarantee of benefits. Plan policies differ and change; your specific coverage is confirmed individually before treatment begins.

Now accepting new patients

Find out where you actually stand.

Request a consult and we'll verify your benefits and walk you through the path for the treatment that fits — including what it costs if insurance doesn't cover it. New patients are typically seen within days.

Request an appointment Call (804) 476-8274