Question 1

Is ketamine therapy covered by insurance?

Accepted Answer

Lumin Health is able to accept most private insurance and Medicare for Spravato (esketamine), which is an FDA-approved version of ketamine. Intravenous ketamine for depression and other forms of ketamine treatment is typically not covered by insurance.

Question 2

Does insurance cover Spravato (esketamine) therapy?

Accepted Answer

Yes. Most private insurance covers Spravato treatment for people suffering from Treatment Resistant Depression (TRD). Costs are typically a co-pay, and allow for ongoing treatment. Lumin Health accepts Medicare and most private insurance plans offered in Massachusetts, including Aetna, Anthem, Blue Cross Blue Shield (BCBS), Cigna, Evernorth, Harvard Pilgrim, Optum, Point32Health, Tufts, and United Healthcare.

Question 3

How can I verify if my personal insurance plan will cover treatment at Lumin Health?

Accepted Answer

When you reach out to the Lumin Health team, our concierges will offer to pursue coverage information on your behalf. We would be grateful to submit prior authorization requests for you and handle all the paperwork so that you can focus on your treatment and getting better. As a result, Lumin Health will verify coverage for ketamine treatment with Spravato.

Question 4

What is the difference in insurance coverage between IV ketamine infusions and Spravato (esketamine) nasal spray?

Accepted Answer

Typically, the difference is quite material between IV ketamine infusions and Spravato (esketamine) nasal spray. As Spravato has full FDA-approval to be a monotherapy for treatment-resistant depression, Spravato has full coverage with plenty of commercial insurance plans. Intravenous ketamine or intramuscular ketamine does not have the same approval, so typical plans do not offer coverage. Spravato has shown parallel efficacy to ketamine therapy and offers a robustly effective and much more accessible option for those with a treatment-resistant depression diagnosis.

Question 5

What are the estimated out-of-pocket costs for treatment if I don't have insurance or my plan doesn't provide coverage?

Accepted Answer

These costs can vary, and we are grateful for the patients that offer this increased level of investment to the treatment. Please get in touch with our team to explore individual options as we do offer sliding scale pricing in the event that cost is a barrier to entry, but typical ketamine infusions at Lumin Health cost around $500 per visit.

Question 6

Are ketamine or Spravato (esketamine) treatments covered by Medicare or Medicaid?

Accepted Answer

The ketamine treatments are covered by neither, but Lumin Health does accept Medicare for Spravato (esketamine) therapy and most other commercial insurance providers.

Question 7

What is "prior authorization," and is it something I will need to obtain for my treatment?

Accepted Answer

Before you receive certain medical care, your insurer must agree that the treatment is medically necessary and that it will be covered under your plan. You will need to obtain prior authorization, but Lumin Health would be grateful to secure that for you. Simply get in touch with us to get the process started.

Question 8

Does my diagnosis (e.g., treatment-resistant depression, PTSD, anxiety) affect whether my insurance will cover the therapy?

Accepted Answer

Yes, a particular diagnosis will have an impact on insurance coverage potential. Esketamine treatment and Spravato coverage is contingent on having a diagnosis of treatment-resistant depression. The reality is that each insurance plan has a different definition of what that means – i.e. the specific number of antidepressant trials conducted and failed — so this is why Lumin Health takes such an active role in handling the prior authorization and coverage components.

Question 9

Do you offer any payment plans or financing options for out-of-pocket expenses?

Accepted Answer

We do. Get in touch with us to learn more — as each situation is unique and deserves careful consideration.

Question 10

Can I use my Health Savings Account (HSA) or Flexible Spending Account (FSA) to pay for my treatment?

Accepted Answer

If you have a Health Savings Account and Flexible Spending Account via credit card, Lumin Health can certainly accept those. You are also welcome to pay out of pocket and request a comprehensive invoice or receipt to try for your own reimbursement.

Question 11

Is ketamine infusion covered by insurance?

Accepted Answer

Typically, ketamine infusions are not covered by Medicare or major private insurance providers. Instead, Spravato (esketamine) is a safe, effective and accessible option with major insurance coverage.