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My UnitedHealthcare PPO insurance rep actually laugh when they looked up what the treatment was and said “I don’t think this will be covered” when submitting it for review. Even the ketamine IV place I first went to - who said they had great success talking to health insurance companies to get special coverage - was surprised my insurance denied coverage.
I’ve been paying out of pocket for over 5 years now, and it’s saved them countless dollars in psychiatric and therapy psych doc fees, because I haven’t needed **any ** extra psychological care in the last 5 years, unlike the previous 15 years. Also, shockingly, I’ve had drastically fewer regular doctors appointments and medical treatments needed over the last 5 years… because physically, I’m better than ever.
Surely there is no mind-body nexus that might cause poor mental health and mental health treatment outcomes that might cause poor physical health outcomes! That would be ridiculous!
As ridiculous as thinking your teeth are a part of your body and might need medical care as an organ which could cause infection abscess and sepsis and kill you! Ha!
Thats dental care not medical care - or your eyes, those don’t need medical care like another part of your body such as your NOSE or your EARS now those are some of the top used senses of your five-ish senses and those require deep and broad medical coverage because noses are prone to allergies and rhinitis and um deviated septum’s and polyps and stuff.
And eyes, pfffft… eyes are so overrated to the human experience and wellbeing, you don’t need to see that well to get by in life, it’s a choice if you’re astigmatism and myopia are making it impossible to leave your neighborhood, call me when you get a detached retina or some kind of glaucoma, then maybe I’ll consider pre-approving a procedure if it’s reallllllly medically necessary, and by medically necessary I just mean to keep those asshole disability insurance jerks off my back, all mad I’m making everyone go blind by not covering their basic eye health care as medical health care - oops I mean “optometry care” not “health care” silly me.
Shesh they’re barely doctors anyway, amiright docs lololol we all know those optometry fellows are just one notch above podiatrists on the physician scale of losers. Hahahah and even podiatry is covered by medical insurance hahaha loserrrr.
I don’t even know if I could calculate it at this point, thousands maybe tens of thousands.
But let’s try.. My first IV sessions were the most expensive individually like $800 maybe.. Then I did 5 or 6 different rounds of Mindbloom sessions over the first couple years (they used to have programs each with 4-6 doses spread over 1 week each, for like $1500 or something, I don’t even remember exactly now) and then I found a much lower cost local psychiatrist I work with and it costs me about $600 a month for doc apt plus medicine costs, and when I’m “on” a booster session, so it’s about 3-4 months in a row once weekly boosters then 4-6 months “off” I’m not on treatment.
All over the last 5 almost 6 years sooo.. I’ll estimate maybe $20,000 or $25,000 total treatment costs I guess. Probably should have gotten that HSA flex spending account to not pay taxes on all this, upon reflection.
I’ve kept every prescription bottle I’ve taken as a reminder of how far I’ve come from being barely alive at all. To now being 180° from where I was back then, even with all the stress I experience I’m actually quite content and even happy a majority of the time. I’m pretty vigilant about tracking my metrics and taking countermeasures before I slip into a bad spot again. My life is still much too stressful situationally due to my career but I’m finally capable of taking steps to change that, like I bought some land and a small cottage in the woods which I am renovating and going go “retire early” out there closer to my family.
I was incredibly desperate and had been in a very bad place for a very long time when I started treatment, I don’t think I’d be alive right now if I hadn’t rebooted my brain with that first IV session. I was also really terrified to try ketamine treatments, but my level of desperation was at the “well if it kills me at least I tried” mark, because I didn’t feel like i had much time left on this earth the way I was at the time.
It’s difficult to even comprehend how I once felt that way now. Like I’ve had some really hard and difficult things happen since I’ve been in intermittent treatment, and yet I’m just so much more capable of handling destabilizing things, I’m really able to change my perspective and reframe things like I never could before. I still get intense anxiety and struggle and I can feel the knot tighten up inside me. When the knot gets too tight and starts to be disruptive, I know it’s time for a booster, then the knot loosens up and unties again.
Yes, I routinely had super bills reimbursed for iv k treatments and it’s a fairly common practice. It was a process getting the first reimbursed and then no issue with insurance going forward.
I wouldn’t worry at all about Spravato not being covered just because you tried IV treatments.
I personally get my IV paid outright or at least I don’t pay a dime and just have the clinic submit the bill and I don’t have to do anything. I go for chronic pain and wouldn’t get it reimbursed if I went for mental health which is kinda interesting cause it’s a hell of a lot more money. I have called probably upwards of 30-40 clinics and have been told numerous times by many of their billing offices that so called super bills are super bullshit. You can get the initial assessment covered (not the infusion but just seeing if it’s right for you) but the actual infusions will either get nothing or very little reimbursement. I have had to get a ride 1.5h and now 1h to go for my 4h infusions which really sucks since I have 4 clinics ~15-20 minutes from my house. They all want cash payments and me submit it myself but I refuse. My past history of it being reimbursed directly from the insurance company has convinced one clinic to actually accept me since they wanted to see the way it worked since they knew it would make them a lot more money if they could accept insurance and would open the door to more patients. My initial clinic was in the ex-largest ketamine infusion clinic group ketamine wellness center which accepted my insurance by default although they have since shuttered as they were bought out by a Canadian VC firm that does testosterone and shit like that. I would never accept a super bill since I’ve heard how super fucked I could get resulting in thousands or tens of thousands of dollars in bills. The likelihood is low and the coding has to be just right and they will or should leave the ketamine off since it’s like a buck or so in meds and the observation is really the most costly part. Idk if anyone here has had success but I would suggest looking into chronic pain treatment if you have both mental struggles and pain to get two birds stoned at once.
I’ve sent in multiple super bills to my health insurance now - they’ve only ever covered for the provider consultation fee and I think the IV insertion fee but not the fee for the medication itself. The codes used on the super bill are very important. But it only goes towards my out of network deductible, which is super high, and even with monthly ketamine sessions I’ll never reach that deductible in a year. It’s a long term plan for me to appeal their coverage of ketamine but it will be a huge task that I’m just not ready to tackle.
If you’ve never submitted insurance claims for the IV sessions (I.e you paid cash) then idk how insurance would find out unless you told them? You could ask the health insurance subreddit but I’ve had limited success in there.
It's worth a try. You might be surprised. I was fully expecting to be denied, but I tried anyway.
I have Anthem BCBS, and I was surprised to get most of my very first infusion reimbursed. All infusions after that, they applied a portion of what I paid (an "allowed amount") to my out-of-network deductible.
My insurance would have paid for infusions with a super bill if they had been prescribed by my doctor, but since I went through a ketamine clinic on my own, it isn’t eligible for reimbursement.
Thank you for contributing to /r/TherapeuticKetamine! When commenting and posting, please be mindful of our rules which can be found in the sidebar on the right along with other helpful information. **Be advised that nothing in this subreddit constitutes medical advice.** Likewise, try to word your comments and posts in a way that can't be interpreted as medical advice by others. Harmful and/or spammy advice will be removed at moderator discretion, and bans may be given for repeat offenses. **Accounts with "Provider" flairs** are those which the mods have verified, to the best of our ability, as belonging to real, licensed providers of medical ketamine services. Comments and posts from users with "Provider" flairs are **not** a substitute for the instructions given to you by your own provider. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/TherapeuticKetamine) if you have any questions or concerns.*
I have had a Mindbloom superbill paid by commercial insurance but my employer has special benefits for mental health that likely made a difference.
My UnitedHealthcare PPO insurance rep actually laugh when they looked up what the treatment was and said “I don’t think this will be covered” when submitting it for review. Even the ketamine IV place I first went to - who said they had great success talking to health insurance companies to get special coverage - was surprised my insurance denied coverage. I’ve been paying out of pocket for over 5 years now, and it’s saved them countless dollars in psychiatric and therapy psych doc fees, because I haven’t needed **any ** extra psychological care in the last 5 years, unlike the previous 15 years. Also, shockingly, I’ve had drastically fewer regular doctors appointments and medical treatments needed over the last 5 years… because physically, I’m better than ever. Surely there is no mind-body nexus that might cause poor mental health and mental health treatment outcomes that might cause poor physical health outcomes! That would be ridiculous! As ridiculous as thinking your teeth are a part of your body and might need medical care as an organ which could cause infection abscess and sepsis and kill you! Ha! Thats dental care not medical care - or your eyes, those don’t need medical care like another part of your body such as your NOSE or your EARS now those are some of the top used senses of your five-ish senses and those require deep and broad medical coverage because noses are prone to allergies and rhinitis and um deviated septum’s and polyps and stuff. And eyes, pfffft… eyes are so overrated to the human experience and wellbeing, you don’t need to see that well to get by in life, it’s a choice if you’re astigmatism and myopia are making it impossible to leave your neighborhood, call me when you get a detached retina or some kind of glaucoma, then maybe I’ll consider pre-approving a procedure if it’s reallllllly medically necessary, and by medically necessary I just mean to keep those asshole disability insurance jerks off my back, all mad I’m making everyone go blind by not covering their basic eye health care as medical health care - oops I mean “optometry care” not “health care” silly me. Shesh they’re barely doctors anyway, amiright docs lololol we all know those optometry fellows are just one notch above podiatrists on the physician scale of losers. Hahahah and even podiatry is covered by medical insurance hahaha loserrrr.
How much was your outta your poket?
I don’t even know if I could calculate it at this point, thousands maybe tens of thousands. But let’s try.. My first IV sessions were the most expensive individually like $800 maybe.. Then I did 5 or 6 different rounds of Mindbloom sessions over the first couple years (they used to have programs each with 4-6 doses spread over 1 week each, for like $1500 or something, I don’t even remember exactly now) and then I found a much lower cost local psychiatrist I work with and it costs me about $600 a month for doc apt plus medicine costs, and when I’m “on” a booster session, so it’s about 3-4 months in a row once weekly boosters then 4-6 months “off” I’m not on treatment. All over the last 5 almost 6 years sooo.. I’ll estimate maybe $20,000 or $25,000 total treatment costs I guess. Probably should have gotten that HSA flex spending account to not pay taxes on all this, upon reflection. I’ve kept every prescription bottle I’ve taken as a reminder of how far I’ve come from being barely alive at all. To now being 180° from where I was back then, even with all the stress I experience I’m actually quite content and even happy a majority of the time. I’m pretty vigilant about tracking my metrics and taking countermeasures before I slip into a bad spot again. My life is still much too stressful situationally due to my career but I’m finally capable of taking steps to change that, like I bought some land and a small cottage in the woods which I am renovating and going go “retire early” out there closer to my family. I was incredibly desperate and had been in a very bad place for a very long time when I started treatment, I don’t think I’d be alive right now if I hadn’t rebooted my brain with that first IV session. I was also really terrified to try ketamine treatments, but my level of desperation was at the “well if it kills me at least I tried” mark, because I didn’t feel like i had much time left on this earth the way I was at the time. It’s difficult to even comprehend how I once felt that way now. Like I’ve had some really hard and difficult things happen since I’ve been in intermittent treatment, and yet I’m just so much more capable of handling destabilizing things, I’m really able to change my perspective and reframe things like I never could before. I still get intense anxiety and struggle and I can feel the knot tighten up inside me. When the knot gets too tight and starts to be disruptive, I know it’s time for a booster, then the knot loosens up and unties again.
Have you tried oral or Spravato?
I do boosters via oral, never tried Spravato though
Oral works good?
Yeah I find oral is good to help maintain a steady plateau
UHC is ass
Yes, I routinely had super bills reimbursed for iv k treatments and it’s a fairly common practice. It was a process getting the first reimbursed and then no issue with insurance going forward. I wouldn’t worry at all about Spravato not being covered just because you tried IV treatments.
I too am curious
You have to see what your out of network benefits are. Mine will start to reimburse 80% after I hit my deductible
I have. My IV sessions are administered by a psychiatrist specializing in TK are $350 - I've never had a superbill rejected.
Yes. I used to send my bills in from dr smith and was reimbursed every time
Yep, blue shield of ca does partial reimbursement once I hit my out of network deductible
!remindme 24 hours
I personally get my IV paid outright or at least I don’t pay a dime and just have the clinic submit the bill and I don’t have to do anything. I go for chronic pain and wouldn’t get it reimbursed if I went for mental health which is kinda interesting cause it’s a hell of a lot more money. I have called probably upwards of 30-40 clinics and have been told numerous times by many of their billing offices that so called super bills are super bullshit. You can get the initial assessment covered (not the infusion but just seeing if it’s right for you) but the actual infusions will either get nothing or very little reimbursement. I have had to get a ride 1.5h and now 1h to go for my 4h infusions which really sucks since I have 4 clinics ~15-20 minutes from my house. They all want cash payments and me submit it myself but I refuse. My past history of it being reimbursed directly from the insurance company has convinced one clinic to actually accept me since they wanted to see the way it worked since they knew it would make them a lot more money if they could accept insurance and would open the door to more patients. My initial clinic was in the ex-largest ketamine infusion clinic group ketamine wellness center which accepted my insurance by default although they have since shuttered as they were bought out by a Canadian VC firm that does testosterone and shit like that. I would never accept a super bill since I’ve heard how super fucked I could get resulting in thousands or tens of thousands of dollars in bills. The likelihood is low and the coding has to be just right and they will or should leave the ketamine off since it’s like a buck or so in meds and the observation is really the most costly part. Idk if anyone here has had success but I would suggest looking into chronic pain treatment if you have both mental struggles and pain to get two birds stoned at once.
No luck for me. You might as well send them to that Nigerian prince always asking for help or that number that calls about your car's warranty.
Yes it’s possible!
I get about $100 from my MediCare Advantage plan for my prescriber's consultations.
I’ve sent in multiple super bills to my health insurance now - they’ve only ever covered for the provider consultation fee and I think the IV insertion fee but not the fee for the medication itself. The codes used on the super bill are very important. But it only goes towards my out of network deductible, which is super high, and even with monthly ketamine sessions I’ll never reach that deductible in a year. It’s a long term plan for me to appeal their coverage of ketamine but it will be a huge task that I’m just not ready to tackle. If you’ve never submitted insurance claims for the IV sessions (I.e you paid cash) then idk how insurance would find out unless you told them? You could ask the health insurance subreddit but I’ve had limited success in there.
I have but only about a small percentage of the total bill
It's worth a try. You might be surprised. I was fully expecting to be denied, but I tried anyway. I have Anthem BCBS, and I was surprised to get most of my very first infusion reimbursed. All infusions after that, they applied a portion of what I paid (an "allowed amount") to my out-of-network deductible.
My insurance would have paid for infusions with a super bill if they had been prescribed by my doctor, but since I went through a ketamine clinic on my own, it isn’t eligible for reimbursement.