Is Ketamine Therapy Covered by Insurance in Los Altos, CA

Ketamine therapy, or ketamine infusion, is generally a treatment option for people experiencing chronic pain, treatment-resistant depression, or other mood disorders such as PTSD, anxiety, and bipolar disorder. Ketamine is also only administered by licensed healthcare professionals if they believe it is necessary. To reinforce this, there should be a lengthy discussion and evaluation to ensure eligibility. On top of that, Ketamine is not by any means a first option for treatment. This means that a person with a history of medications or treatments that have had little to no benefit may start to consider ketamine therapy for their pain or mood disorders with the proper approval.
 
Additionally, there are certain individuals who may not respond well to ketamine therapy, or will not be eligible in general. People with a history of substance abuse, cardiovascular, liver or kidney disease, high blood pressure, and psychosis or schizophrenia are all at risk of adverse effects, which makes it all the more important to discuss medical history with a qualified medical professional, as ultimately, they will be the one to make the decision regarding treatment options. Ketamine is also not for people who are seeing promising results with early forms of treatment such as antidepressants. Ketamine in general is a newer treatment option, another reason why it is not the first option as a treatment.

Ketamine therapy has several factors involved in determining the cost– the location, type of treatment, and provider will all play a role in affecting the cost, but the typical range is anywhere from $400-$2000 per infusion. Out of depression, other mood disorders, and chronic pain, treatment for depression typically costs the least as it requires a lower dosage of ketamine and clinics will typically perform the treatments over the course of a couple of weeks. Pain treatment generally runs the highest in terms of costs out of all ketamine treatments due to the fact that of larger doses while other mood disorders such as PTSD, anxiety, and bipolar disorder cost somewhere between the pain and depression treatment. At our clinic, however, we strive for accessible treatment, running at $750 per infusion. If you have any further questions regarding pricing, feel free to contact us.

Ketamine therapy is generally not covered by insurance. While some insurance plans may cover evaluation or consultation fees, the vast majority stray away from covering ketamine. This is rooted in the fact that it is only FDA-approved as an anesthetic and not as a treatment option for many conditions at this moment. While the FDA approves treatments and medications, they do not oversee the practice of medicine. This is what allows doctors to make “off-label” prescriptions if they believe it to be beneficial– meaning that doctors prescribe a medication to be used in a way that differs from the FDA’s approval.

While ketamine was FDA-approved as an anesthetic in 1970, it is fairly new as a treatment for depression, mood disorders, and chronic pain and is not yet FDA-approved for these conditions. In general, insurance companies are hesitant to cover the costs of non-FDA-approved medications, but some plans may cover consultation or evaluation fees. As of right now, ketamine treatment for depression, mood disorders, and chronic pain is considered “off-label”, meaning that a doctor prescribes a medication or treatment that differs in using the FDA-approved it. This is a very common practice in medicine and the following are common examples of off-label prescribing:
 
Beta-blockers to help with anxiety (generally used to treat high blood pressure)
Topiramate to help treat obesity (generally used to treat epilepsy and prevent migraines)
Modafinal for ADHD (generally used to treat sleep disorders)
 
Fortunately, there are many studies both completed and in progress, that point toward a positive outlook on ketamine treatment. The FDA approving ketamine as an option for these conditions will lead to more widespread insurance coverage of ketamine treatments in the near future. Get specialized and quality care at Bay Area Ketamine Center. Contact us today to learn more about the services we offer. We serve patients from Los Altos, CA, Sunnyvale CA, Palo Alto CA, Stanford CA, Atherton CA, and Cupertino CA.