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How Does Insurance Work?

Current State of Insurance Coverage

Insurance companies may or may not cover ketamine and IV vitamin treatments primarily because they are not obligated to do so. Despite substantial research and demonstrated efficacy in clinical use, insurers consider ketamine and IV therapy treatments experimental, “off label” use and often argue against covering them. 

While coverage for ketamine and/or IV therapy treatment can vary among health insurance plans, certain types of insurance may be more likely to cover. Here are some types of health insurance that may provide coverage for ketamine and/or IV therapy treatment:

Comprehensive health insurance plans: Comprehensive health insurance plans, such as employer-sponsored group plans or individual plans that offer extensive coverage, are more likely to cover ketamine treatment. These plans often include coverage for a wide range of medical treatments and may have more flexibility in covering off-label or experimental therapies.

Mental health coverage: Ketamine treatment is often used for mental health conditions such as depression, anxiety, and post-traumatic stress disorder (PTSD) and etc. Insurance plans that provide robust mental health coverage, including behavioral health services, may be more inclined to cover ketamine treatment and related integration psychotherapy sessions for these specific conditions.

High-tier or premium plans: Higher-tier or premium health insurance plans often offer more comprehensive coverage and may be more likely to cover specialized treatments like ketamine or IV therapy. These plans typically come with higher premiums but provide greater coverage for a wider range of services and treatments.

Medicaid and Medicare: Medicaid, the government-funded health insurance program for low-income individuals and families, may cover ketamine treatment in some states. Additionally, Medicare, the federal health insurance program for individuals aged 65 and older, may cover ketamine or IV therapy for certain conditions if deemed medically necessary.

It’s important to note that even within these types of health insurance, coverage for ketamine and IV therapy treatment is not guaranteed. Factors such as the specific insurance provider, the individual policy, in-patient versus out-patient setting and the documentation of medical necessity can all influence coverage decisions. It’s recommended to review the details of your insurance plan and consult with your insurance company ahead of time and see if prior authorization is available in your specific situation. 

AVYIA’s Insurance Policy

We are pleased to offer patients advice, support, and assistance with superbills that patients can submit to their insurance companies. We strongly suggest you talk to your insurance company first regarding to your coverage. As healthcare providers, we are not the primary customers of insurance companies, and they are not obligated to prioritize our satisfaction and financial well-being. Moreover, mental health services, including ketamine treatments, are often inadequately reimbursed by insurance, prompting many therapists to opt out of coverage to avoid the ongoing struggle for fair payment. 

Due to the inconsistency on reimbursements, our current policy is to not accept insurance for ketamine and IV vitamin treatments. If you would like to receive reimbursement for your treatments and up-to-date information regarding your specific insurance coverage, it is always best to directly contact your insurance provider and inquire about their policies and requirements.

Your Next Steps

If you are suffering and have been considering ketamine or IV therapy, our team is here to help you get started. To ask questions, receive more information, or move forward with treatment, you can contact us at:

Phone: (206) 785-7865 or Email: schedule@avyia.com