Written by Deborah Tan, Avesta Ketamine Wellness Co-CEO
In this Post:
- Ketamine Therapy Costs in Maryland
- Why Do Most Maryland Insurers Not Cover Ketamine?
- Coverage and Financing Options
- The Bottom Line
Patients seek ketamine therapy in Maryland in hopes of resolving their treatment-resistant depression and chronic pain. However, insurers don’t usually cover ketamine, making pricepoint a significant obstacle to healing. Costs vary based on treatment type, provider, and location, but patients often pay several thousand dollars out of pocket.
Fortunately, Maryland providers offer full and partial ketamine coverage in some instances. Additionally, medical assistance programs and private financing options help offset the financial burden.
This article explains how to get ketamine coverage in Maryland, including insurance, financing, and medical assistance programs.
Ketamine Therapy Costs in Maryland: How Does it Work?
Ketamine therapy costs vary based on several factors, including the type of therapy (e.g., infusions, nasal spray, or oral lozenges), the provider’s qualifications, the treatment setting (clinic versus hospital), and geographic location.
Clinics in urban areas like Baltimore might charge more for ketamine therapy due to higher operational costs compared to those in rural or suburban settings. However, the availability of more clinics in urban areas can also lead to competitive pricing.
Costs by treatment type
- Oral Tablets: Oral ketamine tablets are generally the most affordable option, ranging from $75 to $200 per prescription.
- Nasal Sprays: The price for intranasal ketamine sprays can vary from $50 to $300 per bottle.
- IV Infusions: The average cost of ketamine infusions ranges from $400 to $2000 each.
- Spravato: Spravato is an FDA-approved ketamine analog medication. Most Maryland insurers cover Spravato treatment, which means patients pay as little as a $35 co-pay per session at in-network ketamine clinics.
Why Do Most Maryland Insurers Not Cover Ketamine?
Most Maryland insurers do not cover ketamine therapy because the protocol is not FDA-approved for mental health. Officially, ketamine is only sanctioned as a dissociative anesthetic despite decades of evidence proving its powerful mood-elevating properties. Spravato (esketamine) is the only exception. Additionally, most ketamine clinics are out-of-network with insurance providers.
Ketamine is “off-label” for depression and chronic pain.
Ketamine’s lack of FDA approval for depression means Maryland clinicians must administer it off-label, a practice that allows them to prescribe medications for conditions beyond those officially sanctioned. This approach enables patients to benefit from ketamine’s rapid-acting benefits for treatment-resistant depression, suicidality, and chronic pain. The tradeoff is that insurers typically do not cover off-label therapies.
Clinics are often “out of network” with insurers.
Another obstacle in gaining ketamine coverage in Maryland is finding a clinic that is in-network with the insurance provider.
Ketamine clinics are generally “out of network” because of the off-label work they do. Being “out of network” means that ketamine clinics do not have a contract with the insurance provider to offer services at a negotiated rate. This often results in higher out-of-pocket costs for patients since insurance plans typically cover a smaller portion of the bill, or none at all, for out-of-network care compared to in-network services.
Consequently, even if a patient’s insurance plan provides some coverage for ketamine treatments, seeking care from out-of-network providers reduces these benefits.
Avesta’s Bethesda, Maryland, ketamine clinic is in-network with all major insurance companies, including Aetna, Cigna, United Healthcare, Care First, Tricare, and Medicare. Avesta is also an official VA partnership, providing free ketamine therapy for qualified veterans. Contact the team to learn if you’re eligible for in-network benefits.
Ketamine Coverage and Financing Options in Maryland
Despite the obstacles, Maryland patients exploring ketamine therapy have several financial pathways to consider for managing costs. These options include full or partial coverage through private insurance, medical assistance programs, and private financing.
Maryland insurers that cover ketamine
Insurance companies do not typically cover off-label ketamine therapy. However, most standard Maryland providers fully fund Spravato treatments for qualifying patients.
To obtain Spravato coverage, Maryland patients must prove the therapy is medically necessary for their treatment-resistant depression, major depressive disorder, or some other FDA-approved indication. Insurance coverage also stipulates patients must use Spravato in combination with an oral antidepressant.
Off-label coverage
Maryland patients who seek off-label ketamine infusions, sprays, or tablets may also be eligible for coverage or partial reimbursements through several avenues.
- One method involves requesting prior authorization, where the healthcare provider advocates for the necessity of ketamine treatment directly to the insurance company. Insurers sometimes provide coverage in these cases despite ketamine’s off-label status.
- Another avenue is submitting reimbursement claims for ancillary services, such as psychotherapy or medical monitoring, which might be covered even if the ketamine itself is not.
Avesta helps patients secure off-label funding by providing free access to the mobile reimbursement platform Reimbursify. Call Avesta’s insurance team to learn more.
Medical assistance programs
Maryland residents without traditional private insurance benefits can seek financial aid through medical assistance programs. These programs, including government-funded initiatives like Medicaid, provide health coverage and financial assistance to eligible people based on income, age, or disability status.
Medicaid
Maryland residents with Medicaid coverage may be eligible for full Spravato coverage with prior authorization. Patients must have their prescribing physician fill out a Spravato prior authorization form to initiate this process. This form must be submitted to the Maryland Department of Health for approval.
HSA/FSA accounts
Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs) are financial arrangements that allow people to set aside pre-tax to pay for qualified medical expenses.
To cover ketamine using HSA or FSA accounts, Maryland patients must first verify ketamine as an eligible expense, often necessitating a healthcare provider’s prescription or letter of medical necessity. They can then apply their HSA or FSA funds for payment, utilizing pre-tax dollars.
Veterans Affairs (VA) Coverage
Maryland Veterans facing major depressive disorder now have subsidized access to ketamine therapy thanks to pivotal updates in VA policies. These changes officially recognize IV ketamine therapy’s effectiveness, enabling eligible veterans to receive reimbursement under Veterans Care Agreements.
Avesta is privileged to be designated as a VA-approved provider for ketamine therapy in Bethesda, Maryland. This recognition means veterans in the area can access ketamine for free.
Private financing options
Private financing options, like healthcare credit cards, are another invaluable source for covering out-of-pocket costs.
Advanced Care: Advance Care’s healthcare credit offerings include flexible plans with manageable monthly payments, ensuring patients can access ketamine therapy without the stress of upfront costs. Avesta’s clinic in Maryland has a strategic partnership with Advance Care, leveraging their interest-free financing since 2008.
CareCredit: CareCredit is another reputable financing company that offers specialized healthcare financing. CareCredit provides a range of short-term plans featuring low-interest and interest-free options. Patients can apply for a credit line dedicated to ketamine expenses, allowing them to manage the costs through fixed monthly payments.
The Bottom Line
In Maryland, finding ketamine therapy coverage means navigating a maze of insurance issues and high upfront costs. Yet, recent policy changes, clinic partnerships, and financing options are making access easier.
Bethesda residents suffering from treatment-resistant depression can contact Avesta’s insurance experts today to learn about their coverage and private financing options.
