Billing & Insurance for rTMS
As a patient at the MUSC Health Department of Psychiatry, Brain Stimulation Division, you will receive bills from the physicians and from the hospital. MUSC Physicians (MUSCP) submits bills for the professional fees charged by its physicians. The Medical University Hospital Authority (MUHA) bills for hospital facility charges for the use of equipment, space, and supplies. Both MUSC entities participate with Medicare, BlueCross BlueShield, and various other payers and managed care organizations. They do not, however, participate with all payers. Regulations also require us to bill for deductibles and co-payments, even for those insurances with which we participate. Co-payments will be required before or at the time of service.
MUHA may participate with a health plan, but MUSCP may not. In this instance, you would be responsible for paying for the portion of your physician’s bill that your insurance plan does not cover. Depending upon your insurance, you may not receive a bill at all, but instead receive an explanation of benefits, which will outline what your insurance was charged and what was paid on your behalf.
In some instances, your insurance requires a prior authorization before you begin treatment. Without the prior authorization, you will be required to pay for all bills. Some insurers do not require a prior authorization, but whether an authorization is required, it’s still not a guarantee of payment. All payments are based on medical necessity and cannot be determined until the claim is processed. The medical documentation will be reviewed in order for the insurance company to determine payment. Thus there is no guarantee how much is covered and if the insurance company does not cover, then the patient is responsible for payment.
Although the FDA approved rTMS for the treatment of major depressive disorder in 2008, currently not all insurers are willing to cover rTMS for treatment-resistant depression. rTMS has evidence to treat depression after 1 medication treatment failure, but most insurers will not cover rTMS unless a patient has failed to respond to 4 antidepressant medications of adequate duration and dose during this depressive episode and a trial of psychotherapy. Generally, insurers will not cover rTMS for depression in patients with a diagnosis of bipolar disorder.
TMS Clinic: East Cooper
There are no facility charges at this non-hospital based clinic. For most patients paying out of pocket for rTMS at the East Cooper clinic, the cost is $400 for the first session and $200 for each subsequent rTMS session. These rates do not apply at the hospital-based clinic downtown.
For billing questions for the downtown clinic, please call Shayna Epstein at 843-792-1879.
For billing questions for the East Cooper clinic, please call Marlena Therrell at 843-876-0754.
Rates and discounts do change, be sure to confirm with the Brain Stimulation Service for any changes in charges that may not have been updated on this website after 10/26/15.