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Your Cigna Colorado Guide to TMS & Spravato Coverage
Googling “psychiatrist near me that accepts Cigna”? If you’re struggling with depression and medication hasn’t been enough, finding the right path forward can feel overwhelming. At Axis Integrated Mental Health, we are experts in navigating Cigna’s complex system to help you access powerful, effective treatments that can truly change your life. This guide explains how your Cigna benefits can cover Deep TMS and Spravato esketamine therapy.
Why Your Cigna Telehealth App Isn't Enough
Cigna offers several convenient telehealth options for mental health support, including MDLIVE for basic psychiatry, Talkspace for therapy, and other programs like Meru Health, Ginger, and SonderMind.
While these are valuable tools, they cannot provide the advanced, in-person treatments needed for persistent depression. We specialize in providing Deep TMS and Spravato, which require specialized medical equipment and monitoring, all while using your same Cigna coverage.
Your Cigna Coverage: What to Expect
We believe cost shouldn’t be a barrier to wellness. Please note these are estimates based on our experience with many Cigna members; your individual plan may vary.
- Typical Cigna Copay: The average copay for our Cigna-insured patients is $30.
- Deep TMS Costs: This treatment is covered by Cigna after you have tried two or more medications and therapy. You are typically responsible for your specialist copay.
- Spravato Costs: Cigna covers Spravato after two or more failed medication trials. To make it even more affordable, we automatically enroll you in the Spravato Savings Card program. This manufacturer coupon from Janssen Pharmaceuticals can reduce your out-of-pocket cost to as little as $10 per visit with $8,150 reimbursed by Janssen Pharmaceuticals to cover copays, deductibles, and your out-of-pocket max related to treatment.
Clinically Proven Treatments with High Success Rates
When you have treatment-resistant depression, you need a solution with a proven track record. Deep TMS and Spravato offer new hope with impressive results.
Deep TMS (Transcranial Magnetic Stimulation)
This non-invasive treatment uses magnetic pulses to stimulate the areas of the brain linked to mood.
- Success Rate: Studies show that 82% of patients see improvement, and 65% achieve full remission after 4-6 weeks of treatment*. This is a significant increase over older forms of TMS.
- The Experience: Sessions last 30-40 minutes, during which you can participate in our StorySHIFT™ protocol or listen to music. Side effects are typically mild, such as a headache or scalp discomfort.
Spravato™ (esketamine) Ketamine Therapy
Spravato is a prescription nasal spray derived from ketamine that helps your brain build new, healthier neural pathways by promoting neuroplasticity.
- Success Rate: Clinical data shows a nearly 80% improvement rate, with 53% of patients reaching remission*.
- The Experience: Sessions require a 2-hour monitoring period in our comfortable clinic. Common side effects can include dizziness or a feeling of being disconnected, which fade shortly after treatment.
* 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.
Do You Qualify for Coverage?
Cigna will typically authorize these treatments if you meet the following criteria:
- You have a history of trying at least two different types of antidepressants for at least 6 weeks each during your current depressive episode.
- Your current depression is moderate to severe.
- You have a psychiatric evaluation that documents your treatment resistance.
- You have no active substance abuse issues.
- You are at least 18 years old.
- You are able to attend all your treatment sessions regularly.
Our “No-Hassle” Cigna Authorization Strategy
Our team are experts at getting these treatments approved. We manage the entire process for you.
- Complete Documentation: We assemble a full clinical package with medical necessity justifications, your detailed treatment history, and a psychiatric evaluation.
- Fast Submission: We aim to get your prior authorization approved within two weeks of your intake appointment.
- We Fight for You: If there is a denial, we immediately demand a Peer-to-Peer review, where our doctors meet directly with Cigna’s doctors to advocate for your care.
Frequently Asked Questions
A standard Deep TMS schedule is 30 mins a day, 5 days a week for 6 weeks. Accelerated Deep TMS is multiple 10 mins sessions over 6 days. A starting Spravato schedule is twice a week for four weeks, followed by once a week for the next four weeks, with a maintenance schedule determined after that.
We don’t give up. For every denial, our strategy is to demand a Peer-to-Peer review where our providers speak directly with a Cigna doctor to review the medical necessity of the treatment for you.We will never begin a treatment and hold you responsible without a prior authorization. If Cigna continues to deny the prior auth, we can look at alternative solutions, cash-pay discounts, and payment plans.
Both treatments are considered very safe and FDA-Approved for treatment resistant depression. The most common side effects for Deep TMS are mild headache and scalp discomfort. For Spravato, common side effects include dizziness, nausea, and feeling disconnected, all of which are temporary and resolve before you leave the clinic.
Book an appointment with us today. You can book online, call us at 720.400.7025 or email info@axismh.com.
Axis provides Cash Pay Discounts for Deep TMS, charging $5,000 for the standard protocol. Accelerated 6 day protocols are charged at $7,000 total.
Does Cigna insurance cover TMS therapy in Colorado?
Yes, Cigna covers Deep TMS treatment after a history of two or more failed medications and a therapy trial. The typical Cigna copay is around $30.
Does Cigna cover Spravato ketamine therapy?
Yes, Cigna covers Spravato treatment after two or more failed medication trials. A manufacturer savings card can reduce the patient's cost to as little as $10 per visit.
What is required to get Cigna to approve TMS or Spravato?
Coverage requirements include a history of trying at least two antidepressants from different classes for a minimum of 6 weeks each, a moderate-to-severe depression diagnosis, and a psychiatric evaluation.
