Question 1

What is the cost of ketamine treatment with Tufts Health Plan?

Accepted Answer

Lumin Health is considered an out-of-network provider for Tufts Health Plan. This means we cannot bill Tufts directly for your treatment. While Tufts insurance plans often cover Spravato (esketamine) when seeing in-network providers, patients with Tufts insurance will need to pay for their treatment at Lumin Health out-of-pocket. We can provide a superbill for you to submit for potential out-of-network reimbursement, but direct coverage is not available at our clinic.

Question 2

Does Tufts Health Plan cover ketamine for depression, PTSD, and chronic pain?

Accepted Answer

Tufts Health Plan typically covers Spravato (esketamine) for treatment-resistant depression (TRD) if specific medical criteria are met. However, Tufts generally considers IV ketamine infusions and intramuscular ketamine to be investigational and does not cover them. Importantly, because Lumin Health is out-of-network with Tufts, you cannot use your standard in-network benefits here, even for services that Tufts might otherwise cover.

Question 3

How do I get pre-authorization for Spravato (esketamine) with Tufts?

Accepted Answer

Because Lumin Health is not an in-network provider with Tufts Health Plan, we are unable to submit prior-authorization requests to them on your behalf. Patients wishing to proceed with treatment at Lumin Health will need to pay privately. To utilize insurance benefits requiring pre-authorization, you would need to see a provider who is in-network with Tufts.

Question 4

How do I know if I’m a good candidate for ketamine therapy, and how can I start treatment?

Accepted Answer

Ketamine therapy is generally recommended for individuals with serious depression or related conditions that haven’t responded well to standard treatments. At Lumin Health, our experienced medical team will conduct a thorough assessment of your medical history and current symptoms to determine if ketamine or Spravato is appropriate for you. If you are a good candidate and decide to proceed, you can book a free consultation (online or by phone at 617-863-8810). Please note that since we do not accept Tufts Health Plan, our staff will explain our self-pay rates and payment options so you can make an informed decision.

Question 5

Does Tufts Health Plan cover ketamine therapy or ketamine treatment?

Accepted Answer

Tufts Health Plan generally covers the FDA-approved nasal spray Spravato (esketamine) for depression. However, they typically do not cover other forms of ketamine therapy, such as IV infusions or intramuscular injections, for psychiatric conditions. Furthermore, Lumin Health is out-of-network with Tufts, so these policy benefits cannot be applied directly to treatment at our clinics.

Question 6

Does Tufts Health Plan cover Spravato (esketamine)?

Accepted Answer

Yes, Tufts Health Plan policies usually include coverage for Spravato (esketamine) for members with Treatment Resistant Depression (TRD). However, because Lumin Health does not accept Tufts insurance, you would not be able to utilize this coverage for direct billing at our facility and would be responsible for the cost of treatment.

Question 7

Does Tufts Health Plan cover ketamine infusions or ketamine injections?

Accepted Answer

As of 2025, Tufts Health Plan considers ketamine infusions and injections for psychiatric conditions to be investigational and not medically necessary; therefore, they do not cover these treatments. Additionally, since Lumin Health is out-of-network with Tufts, any form of ketamine treatment here would be a self-pay service.

Question 8

Ketamine Infusions vs. Spravato (Esketamine): What's the Difference for Tufts Patients?

Accepted Answer

For Tufts members, Spravato is an FDA-approved medication that may be covered when seeing in-network providers, whereas ketamine infusions are generally not covered by insurance at all. However, at Lumin Health, neither treatment is covered by Tufts directly because we do not participate in their network.

Question 9

Does Lumin Health accept Tufts Health Plan for Spravato treatment?

Accepted Answer

No, Lumin Health does not currently accept Tufts Health Plan. We cannot work with Tufts for initial consults, Spravato therapy, or ongoing care. Patients with Tufts insurance are welcome to receive treatment at Lumin Health as self-pay patients.

Question 10

How can I get Spravato (esketamine) covered by Tufts Health Plan?

Accepted Answer

To get Spravato covered by Tufts, you typically must visit an in-network provider and meet specific criteria (e.g., diagnosis of TRD, history of inadequate response to antidepressants). Because Lumin Health is not in-network, we cannot process this coverage for you. You would need to seek an alternative provider to utilize your Tufts benefits.

Does Tufts Health Plan cover ketamine therapy or ketamine treatment?

Does Lumin Health accept Tufts Health Plan for Spravato treatment?

Are there other resources Lumin Health can recommend?

Frequently asked questions