Insurance Coverage of TMS for Bipolar Depression

A patient represented by an attorney obtained AETNA health insurance coverage for rTMS treatment of bipolar depression.  The patient satisfied the insurer’s policy guidelines for rTMS treatment of major depression by demonstrating failed trials of 4 different medications.  Reimbursement was based on the plan’s allowed percentage of the “covered amount”.  The AETNA Appeals Decision stated: “TMS treatment is being authorized for …