How Your Anthem BCBS Plan Covers Life-Changing Depression Treatment in Colorado

Anthem/BCBS covers dvanced treatments like Deep TMS and Spravato esketamine therapy in Colorado, and are helping people find lasting relief from depression and anxiety. Navigating mental health treatments in Colorado is complex and a barrier to care. Not only do you need to know what cutting-edge treatments are available, which psychiatrists or clinics have access to these treatments, you must also know how insurance determines if you’re eligible for treatment coverage. We wrote this guide and created online cost calculators to make it simpler to understand and help make it easier for people to get care and start feeling better.
At Axis Integrated Mental Health, we specialize in making these transformative therapies accessible and affordable for Anthem Blue Cross Blue Shield members across Colorado. We are experts at navigating Anthem/BCBS’s system to get you the coverage you deserve.

What is Deep TMS (Transcranial Magnetic Stimulation)

Deep TMS is a non-invasive therapy that uses magnetic pulses to stimulate the areas of your brain that control mood.

  • Success Rate: 82% of patients see improvement, and 65% achieve full remission within 6-12 weeks.
  • Treatment Schedule: Sessions are 5 days a week for 6-12 weeks. Each session lasts 20 minutes.
  • Side Effects: The most common side effects are mild headaches and scalp discomfort.
  • Unfortunately, unlike other insurance companies in Colorado, Anthem does not cover TMS treatment for teens 15-18 years old.
  • Read our article more information about TMS costs

What is Spravato™ (esketamine) Ketamine Therapy

Spravato is an FDA-approved nasal spray derived from ketamine that works by promoting the growth of new, positive connections in the brain.

  • Success Rate: Nearly 80% of patients experience improvement, with 53% achieving remission.
  • Treatment Schedule: Treatment typically starts at twice a week for four weeks, then moves to once a week for the next four weeks.
  • Side Effects: Common side effects include temporary dizziness, nausea, or a feeling of being disconnected. Sessions include a 2-hour monitoring period in our clinic.

What Does Depression Treatment Cost in Colorado with Anthem?

If you’d like to get a rough estimate of costs, please use our free, online cost calculators to estimate your out-of-pocket costs for TMS or Spravato. Or, schedule a free consult with a member of our team who can explain how different benefits programs work, the rebates you may be eligible for, and other options.

We Maximize Your Benefits

  • Affordable Copays: The typical copay for our Anthem/BCBS patients is just $30, based on an average of over 350 patients. Please note individual plans vary.
  • Spravato WithMe Savings Card: For Spravato treatment, we automatically enroll you in Janssen’s manufacturer savings program that can reduce your cost to as little as $10 per visit. This program covers copays, deductibles, and your out-of-pocket max.
  • Manufacturer Rebate: With Anthem/BCBS commercial plans you can also get a rebate for observation fees, that can reduce costs further to $0 per treatment if you’re eligible. However, you must enroll in the rebate program and we cannot do this for you.

We Handle the Paperwork

  • Cost transparency: We will provide you with a free financial consult if you’d like and a written estimate if a provider confirms eligibility prior to treatment.
  • Fast Approvals: We are experts at getting prior authorizations approved, often within two weeks of your first appointment.
  • Comprehensive Submissions: Our team prepares a complete clinical documentation package with medical necessity justifications to send to Anthem/BCBS.
  • We Advocate for You: If a request is ever denied, we immediately demand a Peer-to-Peer review to have our doctors speak directly with Anthem/BCBS doctors on your behalf.

We Offer What Telehealth Can't

While Anthem/BCBS offers helpful telehealth options like Anthem Virtual Care via the Sydney Health app and LiveHealth Online, these platforms cannot provide the advanced, in-person treatments required for persistent depression. We provide that next level of care using your same Anthem/BCBS coverage and you can see us in-person or telehealth. Whichever is more convenient for you.

What Patients Say

Want to learn more about TMS or Spravato from real patients? Check out our patient center to get more resources and watch more patient videos for your research.

* The clinical studies referenced in this article provide valuable insights into mental health treatments. However, like all research, they have limitations. Outcomes may vary due to differences in study design, sample sizes, patient populations, and treatment protocols. Some findings may not be generalizable to all individuals, and newer research may expand
or refine these results. This content is for educational purposes only and should not replace professional medical advice. Please consult a qualified healthcare provider to determine the best treatment options for your unique situation.

Am I a Candidate for Coverage?

Your Anthem/BCBS plan will likely cover these treatments if you meet the following criteria:

  • You have tried at least two different types of antidepressants.
  • Each medication was taken at a therapeutic dose for at least six weeks during the current depressive episode.
  • Your current depression is diagnosed as moderate to severe.
  • You have a psychiatric evaluation documenting your treatment resistance.
  • You do not have active substance abuse issues.
  • You at least 18 years old.
  • You are able to attend regular treatment sessions.

Frequently Asked Questions

1. How is this different from the therapy I can get on the Sydney Health app?

Telehealth apps like Sydney Health are excellent for virtual therapy and basic psychiatry. However, they cannot offer medical procedures like Deep TMS or administer medically supervised treatments like Spravato, which are designed for depression that hasn’t responded to other methods.

2. What if I have more questions about depression treatments?

If you still have questions about your costs after using our online calculators, you scan schedule a consult with our team who can answer your questions. Please note, if you’d like to see a board-certified provider, you will need to book an appointment online and we will bill your insurance afterwards.

3. The requirements mention a "therapeutic dose for 6 weeks." What does that mean?

This means you took the medication at the dose level recommended by a doctor for it to be effective, and you took it for a long enough period (at least 6 weeks) to see if it would work for you. Our team will help document this from your medical history.

4. What is the Cash Pay Price for Deep TMS if Anthem doesn’t cover it?

Axis provides Cash Pay Discounts for Deep TMS, charging $5,500 for the standard protocol. Accelerated 6 day protocols are charged at $7,500 total.

5. Why can't you provide a written estimate before I become a patient?

Because of the nature of insurance companies, estimates we provide today may not reflect your insurance status at the time of treatment. For instance, insurance policies may have changed between when we first gave you an estimate to when you started treatment, or you may be required to pay less if you’ve had other medical services from other providers that have gone towards your deductible. We encourage you to get a rough estimate using our online calculators and we will confirm in writing when you’re ready to schedule.

Does Anthem Blue Cross Blue Shield cover TMS therapy in Colorado?

Yes, Anthem BCBS covers Deep TMS treatment after a patient has a history of trying two or more failed medications and a therapy trial. Treatment costs will go towards your deductible and out-of-pocket max .

Does Anthem BCBS cover Spravato ketamine therapy?

Yes, Anthem BCBS covers Spravato after two or more failed medication trials. A manufacturer savings card can reduce the out-of-pocket cost to as little as $10 per visit.

What is required to get Anthem to approve advanced depression treatment?

To get coverage, you must have a history of trying at least two different antidepressants for a minimum of 6 weeks each, have a moderate-to-severe diagnosis, and have a psychiatric evaluation documenting your condition.

Does Anthem cover TMS for adolescents?

No, Anthem only covers TMS for patients 18 and over. We charge $5,500 cashpay for teens 15 years and older for the standard protocol, and $7,500 for accelerated 6 day protocol.

Download Our Anthem/BCBS Mental Health Benefits Guide

Go beyond just googling “psychiatrist near me” and get clarity on what Anthem mental health benefits can do for you. Download our free guide and be better prepared to navigate Colorado’s complex mental health landscape from your very first appointment.