Does Anthem cover TMS in Colorado?
Anthem coverage depends on the member’s specific plan and the current medical-necessity guideline used for review. We verify the plan’s covered diagnosis, documentation requirements, device and protocol criteria, and prior-authorization process before treatment.
Fortifying Wellness is in network with Anthem. We verify your plan’s TMS benefits for free and handle the prior authorization before treatment begins. Questions? Call (720) 432-0958.
What we verify for an Anthem TMS request
Anthem products and review criteria can differ. Here is what typically applies, and what we confirm for your specific plan:
- Typically, insurance covers FDA-cleared standard TMS protocols for major depressive disorder for people who have not had a full response after at least two adequate antidepressant trials. Each policy or situation may differ slightly, and we can help identify what is required for eligibility
- The covered diagnosis and any age-specific criteria in the member’s current guideline
- Required medication, psychotherapy, or augmentation history, including dose, duration, response, and intolerance documentation
- Any baseline symptom scale and FDA-cleared device or protocol requirements
- Ordering-provider, session-count, retreatment, and prior-authorization requirements
Dr. Wagner also completes the independent safety screening for metal or implanted devices, seizure risk, medications, and other clinical factors before treatment.
Coverage criteria are set by your insurer and can change. We verify your plan’s current criteria before treatment begins.
What you’ll actually pay
Your cost depends on your plan’s deductible, copay, and out-of-pocket maximum, so no honest website can quote you a number. One thing worth knowing: in Colorado, Anthem plans are issued by Rocky Mountain Hospital and Medical Service, Inc., and HMO plans by HMO Colorado, Inc. Whichever name is on your card, we verify your benefits, run the prior authorization, and give you a written estimate in plain language before you start. If you’d rather not use insurance, we provide a self-pay estimate the same way.
How the prior authorization works here
- 1
Free benefits check
Call or use the form; our team confirms your Anthem plan’s TMS criteria and your current deductible status.
- 2
Evaluation & documentation
Dr. Wagner’s comprehensive evaluation produces the medication history and clinical documentation Anthem’s reviewers ask for. If your records live elsewhere, we chase them down.
- 3
Submission & written estimate
We submit the request to Anthem’s behavioral-health team, follow it until it clears, and give you a written estimate before your first session.
Not an Anthem member?
Most major commercial plans cover TMS under similar step-therapy criteria. See our guides for Aetna and UnitedHealthcare, or call (720) 432-0958 and we’ll check your plan for free.
Common Questions
Anthem & TMS FAQs
What will TMS cost me with Anthem?
It depends on your plan’s deductible, copay, and out-of-pocket maximum. We verify your exact benefits for free and give you a written estimate before treatment begins.
What if Anthem denies the prior authorization?
Denials are often about missing documentation rather than eligibility, and there is an appeals process we handle. If TMS truly isn’t covered for you, we’ll walk through the alternatives, including Spravato® and self-pay options with a written estimate.
Does Anthem cover Spravato® too?
Anthem plan terms and prior-authorization criteria determine Spravato® coverage. The current FDA label permits Spravato as monotherapy or with an oral antidepressant for adult treatment-resistant depression, but a payer may apply additional criteria. We confirm your plan’s current requirements during the benefits check.
Related reading
Find out what your Anthem plan covers — free
One call. We check your TMS benefits, explain the criteria in plain language, and tell you exactly what your plan requires before you commit to anything.
7345 S. Pierce St, Suite 205, Littleton, CO 80128 · Serving Littleton, Ken Caryl, Columbine, Highlands Ranch, Centennial, Lone Tree, Englewood, Lakewood & the south Denver metro