Is Ketamine Covered By Insurance in Colorado?
Takeaway: Psychedelics are quickly gaining traction as a viable treatment option for mental health conditions, especially depression. Ketamine, an FDA-approved anesthetic, is showing promising and extraordinary results to help people restore their mental well-being, but many insurance companies won’t cover it. In this article, I’ll break down
What ketamine-assisted therapy is,
Why insurance companies don’t tend to cover it, and
Common payment methods for ketamine treatment.
Have you seemingly tried everything to treat your depression? Do you feel like you’re running out of options? If so, you’re not alone.
Many of the one in in the U.S. who have a mental illness struggle to find the right treatment for their mental health – which can seem like a neverending battle, especially if you're navigating through the healthcare system with limited resources and support.
Ketamine is an up-and-coming treatment that many are eager to try. It’s not new to the medical field, but it is one of the new psychedelic medicine treatments to be introduced to the mental health community.
It’s shown to be effective in treating depression and reducing suicidality, but not just by a little. Some studies show up to an 80% success rate in just a few sessions, a statistic that puts it into an entirely separate category from other traditionally used treatments.
Despite these numbers, insurance companies aren’t covering it – leaving millions of Americans without an option that may significantly improve their quality of life.
What is Ketamine-Assisted Therapy?
Initially approved by the FDA in the U.S. as an anesthetic, ketamine gained traction in veterinary medicine as anesthesia for animals. Its popularity is also anecdotally attributed to treating hurt soldiers during the Vietnam War and suicidal patients in an emergency setting.
Since then, ketamine has been used to treat all kinds of different conditions, including chronic pain, post-traumatic stress disorder, and mood disorders like depression.
In 2019, the FDA approved, a nasal spray taken alongside an oral antidepressant. This treatment is only available in an office under the supervision of a medical professional.
Ketamine is also used in conjunction with psychotherapy, which has also shown to be highly effective. (Check out this study).
How Rooted Rhythm Structures Ketamine Treatments
At Rooted Rhythm, we’ve partnered with Journey Clinical’s medical team to offer ketamine-assisted therapy.
A session may last up to three hours and consists of both a talk therapy session with me, a licensed therapist, and the administration of ketamine in the form of a lozenge. We don’t offer other options, such as ketamine infusions or nasal spray.
Ketamine effects usually last around 45 minutes, so the remainder of the session is spent talking about your experience.
It’s common to feel detached and have slowed motor skills during treatment, so you’re reclined and relaxed while receiving the treatment.
You can learn more about each of our ketamine treatment providers and their specific approaches on our about page.
Is Ketamine Therapy Covered by Insurance?
So, we know these new, exciting psychedelic treatments can help improve mental health, but is ketamine treatment covered by insurance?
The short answer is no, not really.
However, there are a few exceptions. In Colorado, Health First Colorado Medicaid plans cover ketamine-related treatment and, on rare occasions, some independent plans that are open to negotiation. Other states have similar plans, but they are few and far between.
Limited Insurance Coverage
Because there are so many moving parts of insurance coverage, it’s tough to pinpoint precisely why many policies don’t cover ketamine. Although ketamine is becoming more acceptable as a treatment in the mental health community, there’s still not enough interest to entice health insurance companies to pay for it.
Some flat-out refuse to cover any type of ketamine treatment, like specific Blue Cross Blue Shield (BCBS) plans, while insurance providers haven’t commented on whether or not they expect to cover it in the future.
Aside from commercial insurance plans, Medicaid and Medicare also don’t cover ketamine treatment – although changing this is a goal for those who advocate for more providers to embrace ketamine as a treatment option.
Off-Label Treatment
Ketamine is also a generic medication that’s only FDA-approved as a pain reliever and an anesthetic in the emergency department and during operations, not as a treatment for mental health conditions.
Clinical Trial Hold-Ups
Without a multi-million dollar (or more) clinical trial and an, on average, ten-year-long approval process, it’s unlikely that ketamine will be added to the coverage anytime soon. These clinical trials are expensive and take decades to complete, making it difficult for providers and researchers to conduct studies on a small or large scale.
A Lack of Provider Education
Education also contributes to why insurance doesn’t cover ketamine. A large portion of healthcare providers aren’t aware of the benefits and uses of ketamine for mental health, so they aren’t talking about it. This isn't because they don't want to, however. Most of the studies are relatively new and have limitations, so further research is needed to solidify it as a commonplace treatment option for conditions like depression.
Those who are part of the ketamine conversation haven’t had the resources to create enough noise to catch insurance companies’ attention, but the group is growing louder. There’s also a lack of central best practices, making it challenging to gather long-term evidence to support FDA approval.
Payment Options for Ketamine Treatment
The promise of alleviating or reducing symptoms with treatment-resistant depression Exploring whether ketamine treatment is covered by insurance helps you assess your financial options for mental health care.
So, how can you get ketamine treatment if your insurance won’t cover it? While we don’t accept insurance policies for our ketamine-assisted therapy, we do work with you to find the best way to financially navigate your treatment. Here are a few options.
Getting a Superbill
A superbill is a document that outlines the services received during your ketamine-assisted therapy sessions, allowing you to file an independent claim with your insurance company.
While you’ll have to pay the total cost of the session upfront and out of pocket, the potential reimbursement through a superbill can make ketamine treatment more financially feasible. Before you submit any documentation, contact your insurance provider to see if you have out-of-network benefits.
HSA/FSA Accounts
Health savings accounts (HSAs) and flexible spending accounts (FSAs) are tax-deductible accounts that pay for eligible medical expenses through your insurance provider.
Ketamine-assisted therapy is sometimes included in these eligible expenses, allowing you to bypass attempting to get your insurance company to reimburse you. However, the IRS ultimately determines what qualifies, so always check with your provider before scheduling any appointments.
Private Pay
Opting for private pay means you are responsible for covering the full cost of the ketamine-assisted therapy out of pocket without insurance reimbursement. Like a Superbill, this payment method involves higher upfront expenses but often offers more flexibility and confidentiality – without the hassle of sometimes complicated insurance requirements.
We do not work directly with insurance companies, but we are always happy to discuss our pricing with you; contact us to learn more.
Looking Ahead to the Future of Ketamine Treatment and Insurance Coverage
The future of ketamine looks bright, with more and more researchers, lobbyists, and clinicians advocating for its use to treat depression. Given ketamine’s current status as an “experimental” drug, reclassifying it as a valid, effective, and safe option to help people improve their mental well-being is necessary, too.
Hopefully, one day the answer to “Is ketamine covered by insurance?” will be yes rather than the lack of coverage we see today. Until then, we plan to offer ketamine-assisted therapy at Rooted Rhythm.
If trying ketamine therapy is something you want to explore, we are happy to see if it’s a good fit for your mental health treatment plan. We offer in-person services in Colorado and Texas, with other locations coming soon.