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Insurance & Coverage

Breakthrough TMS works with major insurance plans, including UnitedHealthcare and Optum, Aetna, Blue Shield of California, Cigna, Anthem Blue Cross, Medicare, Medi-Cal, and TriWest.

Before treatment begins, our team verifies your benefits and walks you through exactly what your plan covers, so there are no surprises.

Plans We Work With

  • UnitedHealthcare
  • Optum
  • Aetna
  • Blue Shield of California
  • Cigna
  • Anthem Blue Cross
  • Medicare
  • Medi-Cal
  • TriWest Healthcare Alliance

Coverage and candidacy vary by diagnosis, insurance plan, and clinical evaluation.

What a Coverage Check Looks Like From Your Side

Consultation is free: meet with our care team to discuss coverage, candidacy, and what treatment looks like for you.

Almost nothing. That is the design. Our staff does the calling; you hand us a card and get an answer back.

Practically, here is the whole of your part. Bring or read us the front and back of your insurance card, the member ID, the group number, and the payer's provider line are all on it. Tell us whether the policy is through an employer, bought directly, or a government plan, and whether anyone else in the household carries a second policy that lists you. Then we take it from there.

What we come back to you with is a plain-language summary: whether your plan includes a TMS benefit, what conditions it attaches to that benefit, where you stand against your deductible, what share of the cost sits with you once the deductible is met, and whether your plan requires authorization before treatment starts. We also tell you what we could not pin down, because a benefits quote from a payer is information, not a guarantee, and pretending otherwise would set you up for a surprise later.

If your plan is not on that list, the answer is still worth getting rather than assuming, call (818) 793-5067 and we will check it.

Prior Authorization, and Where It Fits

Most plans that cover TMS want to approve it in advance. That approval is called prior authorization, and it is the step patients most often have not heard of and most often get stuck on when they try to handle it alone.

What a payer is asking for is documented medical necessity: evidence that TMS is an appropriate next step for you specifically, rather than a first thing to try. In practice that usually means a confirmed diagnosis, a history of antidepressant or other medication trials with the dose and duration of each and how you responded, a record of psychotherapy where relevant, and current symptom scores from a standardized scale. Plans differ in how much of that they want and how recent it has to be.

The order matters, because each step feeds the next:

Consultation, Then Evaluation

The free consultation with our care team comes first. If Deep TMS looks like a fit, you are seen by our supervising psychiatrist, Artur Saakyan, MD, who confirms the diagnosis, takes the treatment history, and completes the safety screening. Nothing can be submitted to a payer before this, the evaluation is what generates the clinical record the payer will read.

Benefits Check, Then Submission

We verify your benefits, then our staff assembles the authorization request and submits it with the supporting documentation. You do not fill out the packet or chase the payer; that is our work, and doing it properly the first time is the single biggest thing that shortens the wait.

Determination, Then Scheduling

The payer reviews and issues a determination, usually approving a specific number of sessions rather than an open course. Turnaround is set by the plan, not by us, and it varies. We will tell you what your plan's stated timeframe is and keep you posted rather than leaving you guessing. Once we have the determination, we book your course.

Two things worth knowing in advance. First, an initial denial is not the end of the road: plans have appeal processes, and a denial is often a documentation gap rather than a judgment about whether you need treatment. Our staff handles the appeal and resubmission. Second, because authorizations are typically granted in blocks of sessions, a course that continues past that block needs a re-authorization mid-treatment. We track those dates so a lapse never interrupts your schedule.

If You Would Rather Not Use Insurance

Some patients choose to pay for treatment directly, because their plan has no TMS benefit, because they do not want a course of treatment documented through their insurer, or simply because they would rather not wait on an authorization. That is a legitimate choice and we are glad to discuss it.

If you go that route, you get the cost of a full course in writing before you agree to anything, with each element itemized, so there is nothing to discover halfway through. We do not publish prices on this page, because the right figure depends on the protocol your diagnosis calls for and the number of sessions in it, and a number posted here would be wrong for most of the people reading it. Ask us directly and you will get a specific answer for your situation, not a range.

Whichever way you pay, the clinical decision comes first and is made the same way. Candidacy is a clinical question, and we do not recommend a protocol because of how it is funded. You get the full picture, and the decision is yours.

Questions About Your Plan?

If you don't see your plan listed, or you're not sure what your benefits include, call us at (818) 793-5067 or email info@tmsbreakthrough.com. Our team will check your coverage for you. Breakthrough TMS is located at 100 W Broadway #1050, Glendale, CA 91210, serving Glendale, Burbank, and the San Fernando Valley.

Find Out What Your Plan Covers

Schedule a free consultation and our team will verify your benefits, explain your coverage, and answer your questions about Deep TMS.

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