How Insurance Actually Works Here
Verifying benefits and obtaining authorization are two different things. Here's the real sequence.
The Distinction That Matters Most
Verifying your benefits tells us what your plan covers in theory. Obtaining authorization is the process of getting your plan to agree to cover your specific treatment. These are separate steps, and both take time.
The Sequence, Step by Step
- Consultation — You meet with our clinical team. We review your history and confirm whether SAINT is clinically appropriate.
- Documentation gathering — We collect the records your insurer requires: treatment history, prior medication trials, and clinical notes.
- Authorization request — We submit the prior authorization request to your insurance carrier on your behalf.
- Decision — The insurer reviews the request and issues a decision. This can take days to weeks depending on the carrier.
- Appeal if needed — If the initial request is denied, we submit an appeal. We handle this process for you.
What We Handle
Our team submits the authorization request and handles appeals on your behalf. You do not call the insurance company yourself. We track the process and keep you informed at each step.
Which Plans Have Options
Some plans — including Blue Cross Blue Shield, AmeriHealth, and Independence Blue Cross — have options within their policies for accelerated TMS. Coverage varies by specific plan and is reviewed case by case.
Medicaid and Medicare Advantage plans generally don't cover SAINT at this time. If you have one of these plans, we'll discuss this with you honestly during the consultation.
What You Can Prepare in Advance
- Your insurance card (front and back)
- A list of antidepressant medications you have tried, with approximate dates and doses if possible
- Records from your current or most recent psychiatrist or prescriber
- The approximate end date of any prior TMS treatment
- Your primary care provider's contact information
Insurance questions are some of the most common ones we hear. Call us at (954) 827-9793 and we'll walk you through what to expect for your specific plan.
Schedule a Free Phone Consultation
No commitment. We'll review your situation, answer your questions, and help you understand whether SAINT or another treatment is the right fit. One phone call — (954) 827-9793.