Is A Ketamine Infusion Covered By Insurance?

Is A Ketamine Infusion Covered By Insurance?

Ketamine infusions are progressively becoming a go-to treatment for many suffering from treatment-resistant mental health issues. After selecting a treatment, the next obvious thought is financing.

Healthcare, in general, is quite costly, and mental health care is no exception. So if you’re considering ketamine therapy, you may be wondering how much it costs and whether your insurance will cover it. The short answer is that most insurance companies do not cover ketamine infusions. Some may cover aspects of the treatment, but not entirely.

If you’re curious about why this is the case, we explain below. But before looking into the reasons why insurance doesn’t cover ketamine infusions, we need to dig a little deeper.

Ketamine Infusions And Depression

Ketamine is a drug that first became popular in the 1960s. It is now common to use as an anesthetic by doctors and veterinarians. It causes dissociative anesthesia and works quickly and effectively in medical settings.

More recently, researchers and medical professionals are becoming more interested in its other uses. Due to their proven ability to treat hard-to-treat mental illnesses, the health and wellness industry embraces ketamine infusions — one of two types of ketamine treatments.

Research on ketamine treatments for mental health and painful conditions is growing progressively. An extensive body of research suggests that subanesthetic doses of ketamine can benefit patients who don’t respond to conventional anti-depressive medication.

A 2012 study confirms the ketamine effects as an antidepressant via ketamine infusions. Researchers administered up to six infusions of ketamine to 24 participants with treatment-resistant depression (TRD). They found that the drug was associated with a “rapid antidepressant” effect.

A more recent review echoes these findings. It involved researchers looking at multiple publications on the effects of ketamine infusions. The researchers concluded that ketamine is a promising treatment option for those suffering from TRD.

They highlight that studies on ketamine mainly focus on short-term effects, but results were still promising. Further investigation is necessary.

Other than researchers attesting to the wonders of ketamine, the number of ketamine clinics that specialize in ketamine therapy also proves its efficacy. Considering all the supporting evidence and several ketamine clinics across the country, why doesn’t insurance cover a ketamine infusion?

Ketamine Therapy Is Still Experimental

The idea of using ketamine to treat mental illness is still relatively new. Though numerous studies suggest its efficacy, most of the studies are small-scale.

Nearly all of these studies encourage further investigation, which could be why insurance companies will not fund treatment.

Many people are still unaware of ketamine therapy and do not even know it may treat mental illness. There are no ongoing campaigns promoting ketamine because some consider it to be an old drug. Therefore, not many people (including some insurance companies) know all its applications.

Hence, insurance companies do not cover the treatment as they are unaware of how it could potentially affect the client.

Other than the general public, not all doctors are on board with using ketamine for mental health, and insurance companies tend to assume guidelines generally adhered to by physicians. This again justifies why insurance companies are reluctant to cover ketamine infusions.

Your insurance may also just flat out refuse to cover the treatment. This is due to the fact that long-term studies are still lacking.

FDA Approval

When a drug is FDA-approved, it means the Center for Drug Evaluation and Research (CDER) has declared it safe to use for consumers. So, when physicians prescribe or administer a drug for a condition that is not FDA-approved, it is described as off-label use.

Many medications are administered off-label, including ketamine infusions. Ketamine was initially FDA-approved for anesthesia in medical settings but not for treating mood disorders. The fact that ketamine infusions are relatively new treatments for mental health and lack FDA approval may be part of why insurance doesn’t fully cover the treatment.

Now you may be thinking, “Why not just have it FDA approved?”.

The answer to that is it’s not so simple. FDA approval is an expensive process, and companies would not be eager to fund studies because of a lack of financial gain.

Unfortunately, it may take some time before ketamine gains approval to treat mental health issues, as the long-term effects still need to be studied more closely.

How Much Does A Ketamine Infusion Cost?

The cost of treatment depends and can vary from one clinic to the next. Firstly, it depends on what you are getting the treatment for, as this determines how many treatments you need.

For example, patients receiving treatment for depression may need anywhere from one to four treatments. On the other hand, patients who suffer from painful conditions can have up to 3 treatments.

Sometimes patients may require follow-up visits where the physician will establish whether further treatment is necessary.

However, on average, an infusion can cost between $200 to $800 (and sometimes more) per session.

Some clinics offer special bundles, making it more affordable per session. So make sure to enquire about such promotions, especially if you need to go for multiple sessions.

Why The Future Remains Bright

Things may appear bleak regarding the current situation around health insurance and ketamine. But it’s important to keep in mind that clinical trials and investigations are ongoing.

Hopefully, if more people are aware of the benefits of ketamine infusions, it will receive enough funding for FDA approval in the next few years. FDA approval of ketamine therapy for mental illness could encourage insurance companies to cover the treatment in the future.

It may also be worth finding out whether your health insurance covers at least part of ketamine therapy. Although unlikely, this may be the case with some companies.

For now, it is crucial that you prioritize your mental health. If you suffer from TRD, consider researching different therapy providers. Many clinics offer affordable options, and some provide interest-free payment plans to suit your budgeting needs.

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Sian Ferguson

View all posts by Sian Ferguson

Sian Ferguson is a freelance writer based in Cape Town, South Africa and she has written for publications such as Healthline, Greatist, and Psych Central to name a few.

Her work focuses on health and wellness, and she's particularly passionate. She believes health content should inform and empower readers, not confuse them!

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