Do Worker’s Comp Benefits cover Ketamine Therapy?

In this post:

• Why are Workers’ Comp Patients Turning to Ketamine?
• How does Ketamine Relieve Pain?
• Does Workers’ Comp Cover Ketamine Therapy for All Pain Patients?
• Does Workers’ Comp Cover Spravato for Pain?
• How Can Workers’ Comp Recipients Get Ketamine Therapy Covered by Insurance?
• How Avesta Ketamine and Wellness Supports Workers’ Comp Patients

If you’re wondering whether Worker’s Comp benefits cover ketamine therapy, the answer is yes–under certain conditions. Ketamine is a valuable medicine for pain relief and management. It is also far safer than opioids. However, Worker’s Comp ketamine coverage depends on several factors, including your insurance provider, state regulations, and your specific plan. Most plans prefer you start with physical therapy or traditional medications. However, many are considering ketamine coverage for chronic pain cases. 

Here’s a look at Worker’s Comp coverage for ketamine therapy, including qualification requirements and how to determine if your plan covers the cost.

Why Are Workers’ Comp Patients Turning to Ketamine?

Most Worker’s Comp patients seek ketamine therapy for pain relief. Workplace injuries vary widely in severity but often lead to long-term discomfort that doesn’t always respond well to standard treatments. Repetitive strain injuries, spinal issues, and severe joint damage can all create lasting aches that disrupt recovery and make it harder to get back to work.

Here’s where ketamine shines.

Ketamine is a dissociative anesthetic with a long history in pain management. The Vietnam War popularized it in the 1970s as a quick, effective analgesic for soldiers. By the 1980s, doctors used ketamine to treat complex regional pain syndrome (CRPS) in specialized clinics, where ketamine-induced comas gave patients temporary relief from intense pain. By the 1990s, ketamine resurfaced as a tool for managing chronic conditions like fibromyalgia and migraines. 

Today, low doses of IV ketamine provide targeted pain relief and recovery without heavy sedation, and the effects often last beyond the treatment session.

Workers’ comp beneficiaries with the following chronic pain conditions from work-related injuries may want to consider ketamine infusions:

• Chronic regional pain syndrome
• Headaches and migraines
• Post-surgical pain
• Back pain
• Joint pain
• Neck injuries
• Nerve damage
• Traumatic Brain Injuries (TBIs)
• Lyme disease

How Does Ketamine Relieve Pain?

Ketamine’s pain-relieving power comes from how it works with the brain. It targets NMDA receptors, which are gateways for pain signals. By blocking these nervous system receptors, ketamine can reduce discomfort and help the brain reset itself. This reboot allows nerve cells to communicate more efficiently, which can help disrupt the pain cycle. 

Science backs this up. In a 2019 meta-analysis, researchers reviewed seven randomized controlled trials that examined ketamine infusions for chronic pain, including neuropathic and mixed types. The analysis showed significant short-term relief, with pain reductions lasting up to two weeks post-infusion–High-dose treatments provided even more substantial relief. 

Does Workers’ Comp Cover Ketamine Therapy for All Pain Patients?

Workers’ comp coverage eligibility for ketamine therapy can depend on a few things: 

• The state you live in
• Your insurance provider and plan
• Ketamine treatment type

States have different rules about what treatments Worker’s Comp will cover, and not all are quick to approve newer protocols like ketamine. Plus, insurance companies usually want to see that other, more traditional therapies—like physical therapy or non-opioid medications—haven’t worked before they’ll approve ketamine.

Another critical factor in determining Worker’s Comp coverage is the ketamine treatment method. Insurers are more likely to cover IV ketamine infusions, which have shown the most promise in treating pain, than nasal sprays or tablets. 

To be sure, check with your insurer to explore your eligibility. Additionally, call a reputable clinic, like Avesta Ketamine and Wellness, to determine whether ketamine can effectively ease your pain. 

Does Workers’ Comp Cover Spravato for Pain?

Workers’ Comp plans do not cover Spravato (esketamine) for pain management. 

The FDA approved Spravato, a ketamine-analog spray, specifically for treatment-resistant depression and major depressive disorder with acute suicidal ideation or behavior but not for any type of pain relief. Because Workers’ Comp typically only covers treatments directly related to work-related injuries and approved medical uses, it won’t approve Spravato for pain. It can, however, cover Spravato for depression.

How Can Workers’ Comp Recipients Get Ketamine Therapy Covered by Insurance?

If you’re a Workers’ Comp recipient interested in ketamine therapy, begin by speaking with your insurance provider and local reputable ketamine clinic. This communication will clarify coverage options, necessary approvals, and any requirements that apply to your plan.

Avesta Ketamine and Wellness simplifies the process for Worker’s Comp beneficiaries near its Virginia, Maryland, and Washington D.C. locations. Avesta’s patient care and insurance teams handle coverage checks, approvals, and paperwork so patients like you can focus on healing. 

Steps to Determine Worker’s Comp Coverage for Ketamine and Avesta:

1. Connect with Avesta: Call Avesta to set up an intake appointment and let the team know you’re a Workers’ Comp patient. They’ll start by assessing your condition and whether ketamine is likely to be covered under your plan.
2. Prepare Your Insurance Details: Have your claim number and Workers’ Comp information ready. Avesta’s insurance team will review your plan and clarify what’s needed for potential coverage.
3. Submit a Prior Authorization Request: You must obtain prior authorization from your Workers’ Compensation provider before scheduling infusions. Avesta’s team will handle this step, ensuring all documentation is completed and submitted accurately.
4. Receive Confirmation of Coverage: Once authorization is approved, Avesta will confirm your coverage details and inform you of any potential costs or copays.
5. Schedule Your Infusion Appointments: With coverage confirmed, you can set up your ketamine infusion sessions at Avesta.
6. Let Avesta’s Experts Manage Communication: Avesta’s team liaises with insurance adjusters throughout the process, ensuring everything runs smoothly. 

If your Worker’s Comp plans approved ketamine therapy, you may pay nothing out-of-pocket. 🎉

How Avesta Ketamine and Wellness Supports Workers’ Comp Patients

Avesta Ketamine and Wellness goes the extra mile to support Worker’s Comp patients like you. You’ve put in hard work and deserve the best possible care. 

Our team provides:

• Insurance Expertise: Avesta’s insurance specialists handle all the tricky details, working directly with your insurance provider to ensure you understand what’s covered. They also handle authorizations, claims submissions, and appeals if needed.
• Transparent Pricing: Avesta is big on transparency. Its billing team gives you a clear picture of your costs upfront. They’ll walk you through your benefits and estimate out-of-pocket expenses so you have all the info to make the best choice for your care.
• Superbills and Claims Help: Avesta provides a detailed superbill for extra claims submissions, so you have everything you need to submit to your insurance. Avesta partners with all major providers and is in-network with Cigna in Maryland, Virginia, and DC.
• No Surprise Bills: Avesta never conducts balance billing, which means they don’t charge you for the difference between what insurance covers and what they bill. Instead, they focus on helping you heal without financial stress.

The Bottom Line

Avesta Ketamine and Wellness makes accessing ketamine therapy through Workers’ Comp simple and stress-free. Their experienced insurance experts manage your financials while their patient care team ensures you get the pain-relieving treatment you need. 
Book a consult with Avesta today to explore Worker’s Comp coverage options for ketamine and start your journey to pain relief.