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For many veterans, it is difficult to return to civilian life after experiencing the stresses of military service. It can lead to a multitude of mental health conditions, such as depression and PTSD, with flashbacks developing. Fortunately, our veterans have access to mental health services through TRICARE, the health care program offered to those who served our country.
In this blog post, we will discuss the treatment covered by TRICARE and the steps to take to get the help you need with your insurance.
What Does TMS Treat?
Transcranial magnetic stimulation (TMS) is an FDA-approved treatment for depression, smoking cessation, and OCD. Various outpatient clinics have found TMS also effective for conditions such as anxiety and PTSD. The use of magnetic pulses creates a current in the brain that boosts the underactive areas associated with depression or PTSD. Veterans struggling with their mental health can find treatment to be beneficial. Luckily, TMS is covered by insurance companies such as TRICARE West, thus offering our veterans the care they need for their mental health.
What Is TRICARE?
TRICARE is a health care program offered to United States military active-duty members, retirees, and their family members. It provides medical care, prescriptions, and dental care. Based on the region you are located in the United States, you may be covered by either TRICARE West or East.
- TRICARE West covers up to 26 states, including but not limited to California, Colorado, Hawaii, Idaho, and much more.
- TRICARE East covers up to 28 states, including but not limited to Maryland, Georgia, Kentucky, and Maine.
What is the Difference Between TRICARE Prime and Select?
TRICARE has two plans which offer differing flexibility based on the plan you choose. TRICARE prime tends to be less flexible, but has lower out-of-pocket costs than TRICARE Select.
- TRICARE Prime is an HMO-style plan with an assigned primary care provider, but requires referrals for specialty care.
- TRICARE Select is a PPO-style plan that allows patients to see any authorized provider without referrals.
To learn more about the difference between the two TRICARE plans, click here.
Steps to Getting Care with TRICARE
TRICARE West covers TMS only for the treatment of depression. For TMS to be approved under your TRICARE insurance, there are several steps to take first.
1. Visit a Primary Care Doctor or Psychiatrist
- During this visit, you will be discussing your history of depression.
- In order for TMS to be covered by insurance, it requires two failed attempts with antidepressants. The provider will also discuss prior therapy sessions you have tried.
2. Find a TMS Provider
- Search for a psychiatric clinic or TMS practice that accepts TRICARE West.
3. Prior Authorization with TRICARE
- Once you find an office, you will meet with the clinician, who will discuss your treatment history and then will submit a prior authorization directly to TRICARE West. This appointment is known as the intake.
- The review process takes approximately 1-2 weeks.
4. Begin Treatment
- After approval from TRICARE West, you can attend your appointment, at which time you will be assigned to your treatment location.
- Insurance companies typically cover around 36 sessions, but more treatments can be covered if deemed necessary.
What is NeoPsych Contracted With?
As a private practice located in the greater Los Angeles area, we are contracted with TRICARE West. NeoPsych is an authorized provider for TRICARE. Feel free to call with any questions regarding TMS with TRICARE.
Dr. Thomas Hughes is an adolescent and adult interventional psychiatrist. He is the owner and founder of Heard Medical and NeoPsych in Glendale, CA. He specializes in medication management and Transcranial Magnetic Stimulation for depression, anxiety, OCD, and PTSD.
Esha Nushrat is a pre-medical student interested in Neurology. She has been working in mental health and volunteers at organizations such as Stride in Recovery and NAMI