Everything you need to know about your benefits, your options, and how to get the care you deserve without the runaround.
Introduction
Mental health care in Colorado has never been more accessible, but figuring out what your insurance actually covers can feel like a second job. Prior authorizations, deductibles, in-network requirements, plan-specific restrictions: the system was not designed with patients in mind.
This guide was. Whether you are exploring therapy for the first time, considering medication management, or looking into advanced treatments like Deep TMS or Spravato for treatment-resistant depression, this page will walk you through exactly what major Colorado insurance plans cover, what questions to ask, and what to expect from the moment you pick up the phone.
Axis Integrated Mental Health is in-network with most major insurance carriers across our Colorado Front Range locations, including Anthem BCBS, Aetna, UnitedHealthcare/Optum, Cigna/Evernorth, Colorado Medicaid, Medicare, Tricare, UMR, and First Health/Cofinity. No referral is required to book your first appointment.
What Mental Health Services Does Insurance Typically Cover in Colorado?
Before diving into individual plans, here is what most commercial insurance plans cover for mental health in Colorado:
- Psychiatric intake appointments. Your initial 60-minute evaluation at Axis with a psychiatric provider is covered by most plans. No referral needed.
- Medication management. Follow-up appointments for ongoing psychiatric medication management, typically 30 minutes, are covered by most plans subject to your copay or coinsurance.
- Therapy. Individual therapy sessions are covered under behavioral health benefits. Session limits and cost-sharing vary by plan.
- Spravato (esketamine nasal spray). FDA-approved for treatment-resistant depression and major depressive disorder with suicidal ideation. Covered by most major commercial plans, though prior authorization is required. Axis handles the authorization process on your behalf.
- Deep TMS (Transcranial Magnetic Stimulation). FDA-cleared for treatment-resistant depression. Covered by most major commercial plans for patients who meet clinical criteria, typically two or more failed antidepressant trials with a documented depression diagnosis.
Federal mental health parity laws require that insurance plans cover mental health benefits comparably to medical and surgical benefits. That means your insurer generally cannot impose more restrictive limits on behavioral health care than they would on a physical health condition.
Coverage by Insurance Plan
Anthem Blue Cross Blue Shield (BCBS)
Anthem is one of the largest insurance carriers in Colorado and covers a broad range of mental health services through its Carelon behavioral health network.
What Anthem covers at Axis:
- Psychiatric intake and medication management
- Individual therapy
- Deep TMS for treatment-resistant depression (prior authorization required)
- Spravato for treatment-resistant depression (prior authorization required)
Anthem requires prior authorization for TMS and Spravato. Clinical criteria typically include two or more failed antidepressant trials and a documented depression diagnosis. Axis submits prior authorization on your behalf and manages the paperwork from start to finish. Your out-of-pocket cost depends on your specific Anthem plan, as copays, coinsurance, and deductible requirements vary.
Aetna
Aetna provides behavioral health coverage through its standard commercial plans and is in-network with Axis at multiple Front Range locations.
What Aetna covers at Axis:
- Psychiatric intake and medication management
- Individual therapy
- Deep TMS (prior authorization required)
- Spravato (prior authorization required, coverage through Aetna Better Health and standard commercial plans)
Aetna’s prior authorization process for advanced treatments requires clinical documentation of prior treatment failures. Axis coordinates that process directly with Aetna so patients are not navigating it alone.
UnitedHealthcare / Optum / UMR
UnitedHealthcare is one of the most widely held plans in Colorado, and its behavioral health arm, Optum, manages coverage for most mental health services. UMR, a self-funded plan administrator under UHC, is also accepted at Axis.
What UnitedHealthcare covers at Axis:
- Psychiatric intake and medication management
- Individual therapy
- Deep TMS (prior authorization required)
- Spravato (prior authorization required)
UnitedHealthcare’s prior authorization process for TMS and Spravato can be detailed, but Axis has extensive experience navigating it. If a prior authorization is initially denied, Axis immediately requests a peer-to-peer review between our clinical team and the insurance medical director. Under Colorado’s mental health parity law, UHC cannot apply more restrictive standards to TMS than it would apply to a comparable medical procedure.
Cigna / Evernorth
Cigna manages behavioral health benefits through its Evernorth platform. Axis is in-network with Cigna at Front Range locations, which is significant: many mental health providers in Colorado do not accept Cigna.
What Cigna covers at Axis:
- Psychiatric intake and medication management
- Individual therapy
- Deep TMS (prior authorization required)
- Spravato (prior authorization required)
Cigna’s network for psychiatric providers in Colorado is limited, making Axis’s in-network status a meaningful advantage for Cigna members seeking advanced treatment. Prior authorization requirements for TMS and Spravato are similar to other commercial carriers, and Axis submits on your behalf.
Colorado Medicaid
Colorado Medicaid covers mental health services through the Behavioral Health Administrative Service Organization (BH ASO) and regional managed care programs. Axis accepts Colorado Medicaid across multiple locations, making it one of relatively few advanced treatment providers in the state to do so.
What Colorado Medicaid covers at Axis:
- Psychiatric intake and medication management
- Individual therapy
- Spravato for treatment-resistant depression (prior authorization required)
Medicaid copays for mental health services are generally minimal, often $0 to $3 per visit.
Medicare
Medicare Part B covers outpatient mental health services, including psychiatric visits and therapy. Coverage for TMS under Medicare has expanded in recent years for qualifying patients with treatment-resistant depression.
What Medicare covers at Axis:
- Psychiatric intake and medication management
- Individual therapy
- Deep TMS (subject to Medicare coverage criteria and prior authorization)
- Spravato coverage under Medicare varies; contact our team to verify
Medicare typically covers 80% of approved mental health services after the Part B deductible, with the patient responsible for the remaining 20% unless you have a supplemental (Medigap) policy. Contact our intake team to verify your specific Medicare plan’s coverage for TMS or Spravato before scheduling.
Denver Health
Denver Health operates two distinct plan types that work quite differently for patients seeking mental health care at Axis.
Denver Health Medicaid
Denver Health Medical Plan administers Medicaid coverage for many Denver residents through the Colorado Medicaid program. Axis accepts Denver Health Medicaid. Covered services include psychiatric intake and medication management, individual therapy, and Spravato for qualifying patients with treatment-resistant depression. Deep TMS is not covered under Colorado Medicaid, including Denver Health’s Medicaid plan. Copays are generally minimal, often $0 to $3 per visit.
Denver Health POS (Point of Service) Plan
The Denver Health POS plan is a commercial plan available to Denver Health employees and some employer groups. As a point of service plan, it gives members the option to see both in-network and out-of-network providers, though staying in-network results in significantly lower out-of-pocket costs. Coverage for mental health services under the POS plan typically includes psychiatric visits, medication management, and therapy. Coverage for advanced treatments like Deep TMS and Spravato depends on the specific plan design and whether prior authorization criteria are met.
What to know before scheduling: Denver Health plan benefits vary depending on whether you are on the Medicaid plan or the commercial POS plan, and coverage details can differ even within the same plan type. The best step before scheduling is to contact our intake team so we can verify your specific Denver Health benefits and confirm what is covered before your first visit.
First Health / Cofinity
First Health and Cofinity are network access programs used by self-funded employer health plans. If your insurance card shows First Health or Cofinity as your network, Axis may be in-network with your plan depending on your employer’s benefit design.
Because First Health and Cofinity are network administrators rather than insurance carriers, your specific benefits depend entirely on your employer’s plan design. Contact our intake team with your insurance card and we will verify participation and benefits before you schedule.
Not Sure What Treatment Will Cost? Find Out in Under 60 Seconds.
Deep TMS and Spravato are covered by most major insurance plans, but your out-of-pocket cost depends on your specific benefits, and the range can be wide. Rather than leave you guessing, Axis built a free cost calculator so you can get a real estimate before you ever pick up the phone.
Enter your insurance details and the calculator returns an estimated cost based on how your plan actually works, including your deductible status, coinsurance, and out-of-pocket maximum. For Spravato, it also accounts for the Janssen WithMe Savings Card program, which can significantly reduce what you owe. No insurance data is stored. No obligation to schedule.
This is an estimate, not a guarantee. Axis verifies your exact benefits before any treatment begins so there are no surprises when you start care.
Use the free calculator at axismh.com/spravato-deep-tms-cost-calculator
What Prior Authorization Means and Why It Matters
Prior authorization (sometimes called prior auth or PA) is approval from your insurance company that must be obtained before certain services begin. For mental health treatment, prior auth is most commonly required for:
- Deep TMS
- Spravato
- Intensive outpatient programs (IOP)
- Partial hospitalization programs (PHP)
- Certain medications
If a service that requires prior authorization is provided without approval, the claim can be denied even if the service is otherwise covered under your plan. That denial becomes your financial responsibility.
Axis submits prior authorization for TMS and Spravato and for medications that require prior authorization on every patient’s behalf. Our clinical team provides the documentation insurers require: diagnosis records, treatment history, evidence of prior antidepressant trials, and supporting clinical notes. If an authorization is denied, we request a peer-to-peer review immediately. If the appeal is unsuccessful, we help patients escalate to the Colorado Division of Insurance under mental health parity protections.
You should never have to navigate that process alone.
Questions to Ask Your Insurance Before Your First Appointment
If you want to call your insurer directly before reaching out to us, these are the most useful questions to ask:
- What are my mental health benefits for outpatient psychiatric care?
- What is my deductible, and how much have I met so far this year?
- What is my copay or coinsurance for outpatient behavioral health visits?
- Does my plan cover TMS therapy? What is the prior authorization criteria?
- Does my plan cover Spravato (esketamine)? What are the coverage requirements?
- Do I need a referral to see a psychiatrist or psychiatric nurse practitioner?
- What is my out-of-pocket maximum for this plan year?
Or skip the hold music and let our team do it for you. When you reach out to Axis, we verify your benefits directly with your carrier and give you a clear picture of your coverage and estimated costs before you schedule.
What If I Don’t Have Insurance?
For patients without insurance, who are out-of-network, or who prefer to pay directly, Axis offers straightforward self-pay rates:
| Service | Self-Pay Rate |
|---|---|
| Psychiatry intake (60 min) | $300 |
| Therapy intake (60 min) | $180 |
| Psychiatry follow-up (30 min) | $200 |
| Therapy follow-up (30 min) | $150 |
| Deep TMS, full course (36 sessions) | $5,500 |
Spravato pricing varies. Contact our team for details.
Under federal law, patients who are uninsured or who choose not to use insurance are entitled to a Good Faith Estimate of expected charges before services begin. Axis provides this as part of our standard intake process.
What If I Have Questions About My Bill?
Billing questions are normal, and we would rather you ask than sit with confusion about a charge. If you receive a statement that does not match what you expected, reach out to our team before assuming the amount is final.
If you received an Explanation of Benefits (EOB) from your insurance company, that is not a bill. It shows how your claim was processed and what portion you may owe, but wait for a statement from Axis before making any payment.
If your statement shows a balance you were not expecting, it may be due to a deductible that had not been met, a coinsurance requirement, or a claim that processed differently than your benefits estimate suggested. These situations are common and usually have a straightforward explanation.
Our team can walk you through any charge on your statement, help you understand how your insurance processed the claim, and connect you with the right resource if something does not look right.
Understanding Your Insurance Terms
- Deductible. The amount you pay before your insurance starts sharing costs. If you have not met your deductible, you may pay the full allowed amount for services until you do.
- Copay. A fixed dollar amount per visit, set by your plan. It does not change based on what your provider charges.
- Coinsurance. The percentage of costs you pay after your deductible is met. If your plan pays 80%, you pay 20%.
- Out-of-pocket maximum. The most you will pay for covered, in-network services in a plan year. Once reached, your insurance covers 100% for the rest of the year.
- In-network. A provider with a contract with your insurance company, typically resulting in lower cost-sharing.
- Prior authorization. Advance approval from your insurer required before certain services begin.
- EOB (Explanation of Benefits). A document your insurer sends after a claim is processed. It is not a bill.
Should You See Your PCP or a Psychiatric Specialist?
Your primary care provider (PCP) is often the first person who brings up antidepressants or ADHD medication, and for a lot of people that is the right place to start. PCPs are trained to manage straightforward cases, and many patients do well staying with their family doctor for mental health medication over the long term or FAMLI leave, since they already have a history with you.
That said, there are situations where a psychiatric specialist is a better fit, and knowing the difference can save you months of trial and error.
When a PCP Is a Reasonable Starting Point for Mental Health Issues
If any of the following describe you, starting or staying with your primary care provider for mental health medication management is generally appropriate:
- You are considering antidepressants for the first time and your symptoms are mild to moderate
- You have a straightforward depression or anxiety diagnosis with no significant history of treatment failure
- You have ADHD that is already well-controlled on a stable medication and dose
- You have a good relationship with your PCP and your symptoms are responding to your current treatment
- You are not experiencing significant side effects and your functioning has improved
For these patients, a PCP can prescribe, monitor, and adjust medications effectively. Staying with your primary care provider also tends to be simpler from a scheduling and insurance standpoint.
When It May Be Time to See a Psychiatric Specialist
Psychiatric care becomes more important when the picture gets more complex. If your PCP is doing their best but your symptoms are not improving, or if you have been through more than one medication without good results, a psychiatrist or psychiatric nurse practitioner brings a deeper level of clinical training and more treatment options.
Consider reaching out to a psychiatric specialist if any of the following apply to you:
- You have tried two or more antidepressants and they either did not work or caused side effects that made them hard to tolerate
- Your symptoms improved at first but have stopped responding to your current medication
- You are experiencing significant side effects that your PCP has not been able to resolve by adjusting your dose or switching medications
- Your depression feels severe, has lasted more than a few months, or is interfering with your ability to work, maintain relationships, or care for yourself
- You have thoughts of self-harm or suicide, even passively
- You have been diagnosed with both depression and another condition such as anxiety, bipolar disorder, OCD or PTSD, and managing all of them feels beyond what your PCP is comfortable treating
- You have been told you may have treatment-resistant depression, or a provider has mentioned TMS or Spravato as options
- You want to safely deprescribe from psychiatric meds and want additional supports like TMS or Spravato to help
- You feel like your mental health needs more time and attention than a brief primary care appointment allows
None of this means your PCP did anything wrong. Primary care providers are generalists, and complex psychiatric presentations require a level of specialization that falls outside the scope of most family medicine or internal medicine practices. It’s similar to seeing an orthopedist for a knee injury rather than a primary care physician. Both can help but an orthopedist will have an increased tool set to offer. Seeing a specialist is not a last resort: it is simply the right level of care for a more complex situation.
What a Psychiatric Specialist Can Offer That a PCP Typically Cannot
- A comprehensive psychiatric evaluation that looks at your full history, not just your current symptoms
- Access to a broader range of medications and dosing strategies, including combinations that require closer monitoring
- Clinical expertise in treatment-resistant depression and conditions that have not responded to first-line treatments
- Access to advanced treatments like Deep TMS and Spravato, which require a psychiatric evaluation and ongoing clinical oversight
- More time per appointment to review what has and has not worked, and why
At Axis, no referral is required to book an intake appointment. If you are not sure whether your situation warrants a specialist, our intake team can help you figure that out before you ever schedule. And we can also work in collaboration with your primary care physician to ensure that your mental and physical health are considered together when building your treatment plan. Many patients continue to have their medications prescribed by their primary care physician but add on services like Deep TMS and Spravato through Axis.
Why Patients Choose Axis Integrated Mental Health for Mental Health Care
Most advanced treatment clinics in Colorado operate on a cash-pay model. Boutique TMS providers and many psychiatric practices either do not accept insurance or accept only a handful of plans. Axis was built differently.
We accept most major insurance carriers for every service we offer including Deep TMS and Spravato. We handle prior authorizations, manage appeals, and advocate on our patients’ behalf when coverage is disputed. Our intake team verifies benefits before your first appointment so you know what to expect financially before you ever walk through the door.
We are locally owned, mission-driven, and the only clinic who has won a ColoradoBiz Magazine award for Top Startup of the Year, Best of Mile High Awards 3 years in a row, Boulder County Gold’s Best Mental Health Clinic of the Year, and Denver Business Journal’s Partners in Philanthropy Award.
Ready to find out what your plan covers?
Contact our team and we will verify your benefits, answer your questions, and get you scheduled, usually within a week.
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