Money shouldn’t
be the reason you wait
Spravato®, psychiatry, psychotherapy and medical visits are covered by many major plans. Ketamine therapy usually isn’t. We check your benefits first and give you the real number before you commit.
Most plans cover Spravato® and psychiatry.
We check yours first, for free.
Anthem Blue Cross
Aetna
Blue Shield of California
Cigna (Evernorth)
UnitedHealthcare (Optum)
Medicare
Your plan, service by service
Accepting your insurance and covering the treatment you came for are two different things. Here is where each service usually lands, before we check your exact plan.
Usually covered5 servicesBilled to your plan. Your share depends on your deductible and copay. | |
| Spravato® (esketamine) | Covered on most major plans once criteria are met. Prior authorization required, which we handle. |
| Psychiatry & medication management | Billed as medical care, including your initial evaluation. |
| Psychotherapy | Covered on many plans. If not, we give you a superbill for out-of-network benefits. |
| Medical consultation & intake | Often billable, even when the treatment it leads to is not. |
| Integrative medicine consultation | Billed as a medical visit, the same as other consultations. |
Depends on plan1 serviceWe check before your first visit, so there are no surprises. | |
| Palliative consultation | Covered on many plans as specialist medical care. |
Self-pay3 servicesYou’ll know the price before you book. A superbill may bring part of it back. | |
| Ketamine therapy & KAP | Prescribed off-label, so almost no plan covers the medicine or the session. Superbill provided. |
| Acupuncture & soundbed | Not covered on most plans. |
| Nutrition & hormone health consultations | Not covered on most plans. |
The treatment most plans cover
Spravato® is FDA-approved for treatment-resistant depression, so most major plans have a path to pay for it. Here is what that path asks for, and the parts we take off your plate.
- 01
Two prior antidepressants
Most plans ask for records showing at least two antidepressants haven’t worked well enough in your current episode. It’s the most common cause of delay, and usually a paperwork fix, not a clinical one.
- 02
Prior authorization
Your plan approves treatment before it starts. We prepare and submit the request with your medication history, and follow it through appeal if the first answer is no.
- 03
A certified clinic
Spravato® can only be given in a REMS-certified setting, with two hours of monitoring after each dose. Our Santa Monica clinic is certified.
The FDA now approves Spravato® on its own, without an oral antidepressant. Many plan policies haven’t caught up. If yours denies on the older criteria, that’s a known, appealable situation, and we handle the appeal.
Paying out of pocket?
Ketamine therapy is self-pay. If your plan has out-of-network benefits, a superbill lets you claim part of it back. Here is exactly how that works.
- 01
You pay at your visit
You’ll know the price before you book. Self-pay services are paid at the time of care.
- 02
We give you a superbill
An itemized receipt with the diagnosis and procedure codes your insurer needs. Always included.
- 03
You submit it to your plan
Most insurers take it through their app or member portal. Some want a CMS-1500 form; we’ll tell you which.
- 04
Your plan decides
They review your out-of-network benefits, deductible and allowed amount. Any reimbursement is paid to you.
No one can promise an amount in advance. It depends on your out-of-network benefits, your plan’s allowed amount, and how much of your deductible you’ve met. Decisions often take weeks, and a first denial is worth appealing more often than people assume.
We check first.
Then we tell you the number
- 01
We verify your benefits
Before your first appointment, we contact your plan directly instead of guessing from the card.
- 02
You get the real figure
What’s covered, what isn’t, your share, and anything still uncertain, in plain language.
- 03
Then you decide
Nothing is booked until you’ve seen the number and said yes to it.
Financing is available. Bring up cost early and we’ll build a payment plan around it.
Common questions
Questions about coverage
Do you take my insurance?
We bill Anthem Blue Cross, Aetna, Blue Shield of California, Cigna (Evernorth behavioral health), UnitedHealthcare (Optum behavioral health) and Medicare directly. Your coverage still depends on your specific plan, so we verify it for free before your first visit.
Why is Spravato® covered when ketamine therapy isn’t?
Spravato® is FDA-approved for treatment-resistant depression, so plans have a defined path to cover it. Ketamine therapy is prescribed off-label, which is why almost no plan covers the medicine or the session.
Is the medical consultation covered even if the treatment isn’t?
Often, yes. The consultation, the psychiatric evaluation, and medication management are billed as ordinary medical services and are covered on many plans, even when the treatment they lead to is self-pay. This is why it is worth verifying benefits regardless of which path you are considering.
What happens if my plan denies Spravato®?
Denials are common and frequently reversible. The usual reason is documentation: the plan wants evidence that two antidepressants did not work well enough during the current episode, and that history is often spread across several previous prescribers. We gather it, submit the prior authorization, and pursue the appeal. A first denial is not the end of the conversation.
How much will I get back from a superbill?
No one can tell you reliably. It depends on whether your plan includes out-of-network benefits, what the plan considers an allowed amount for each code, and how much of your deductible you have already met. Some patients recover a meaningful portion, others recover nothing. We give you a complete, correctly coded superbill so the claim is as strong as it can be, and we will help you read the response.
Will you bill my insurance for me?
For covered services, yes, we bill your plan directly. For self-pay services we cannot bill on your behalf, because the service is out of network by definition. What we do instead is give you a superbill with everything your insurer needs, so you can submit the claim yourself.
Do you offer financing?
Yes — flexible payment plans are available for self-pay treatment. Raise cost early and we will build the plan around it.
Spravato® is a registered trademark of Janssen Pharmaceuticals, Inc.