A patient represented by an attorney obtained AETNA health insurance coverage for rTMS treatment of bipolar depression. The patient satisfied the insurer’s policy guidelines for rTMS treatment of major depression by demonstrating failed trials of 4 different medications. Reimbursement was based on the plan’s allowed percentage of the “covered amount”.
The AETNA Appeals Decision stated –
“TMS treatment is being authorized for member’s persistent symptoms of a depressive disorder and failures to make significant improvement from either psychotherapy known to be effective in the treatment of major depressive disorder and from trials of antidepressant psychopharmacologic agents and other therapeutic interventions.”
For legal help in getting an insurance company to pay for mental health care, contact Kate Spielman, katie@dllawgroup.com, DL Law Group, https://www.dllawgroup.com (415-678-5050).
It is worth noting that the original report of TMS’s effectiveness by Mark George in 1995 included one patient with complete remission of symptoms after three years of depression… It later turned out that that patient was bipolar…
George MS, Wassermann EM, Williams WA, Callahan A, Ketter TA, Basser P, Hallett M, Post RM. Daily repetitive transcranial magnetic stimulation (rTMS) improves mood in depression. Neuroreport. 1995 Oct 2;6(14):1853-6. PubMed PMID: 8547583.
For more information on mental health parity legal issues in California…
Mental Health Parity Victory in California
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