Trying to understand insurance coverage for mental health treatment can feel overwhelming, especially when you’re already exhausted, discouraged, or just trying to feel better. Many people reach out to us at Anew Therapy feeling unsure where to start, worried about cost, or afraid of being told “no” by their insurance provider.
If that’s you, take a breath. You’re not alone, and you’re not doing anything wrong by asking questions.
This guide is here to walk you through insurance coverage for TMS, ketamine therapy, and Spravato (esketamine) in Utah: what’s typically covered, what isn’t, and how to advocate for yourself along the way.
Why Insurance Coverage for Advanced Mental Health Treatments Can Feel So Confusing
Traditional antidepressants are often covered without much friction. But treatments like TMS, ketamine, and Spravato fall into a newer category of care, which means insurance companies often require more documentation, prior authorizations, and clinical justification.
That doesn’t mean these treatments aren’t legitimate or effective. It simply means insurers want evidence that they’re medically necessary, particularly for individuals with treatment-resistant depression.
Understanding this context can help you feel less discouraged and more empowered as you navigate your options.
Does Insurance Cover TMS Therapy in Utah?
Yes – in most cases, insurance does cover TMS therapy in Utah.
TMS (Transcranial Magnetic Stimulation) is FDA-approved for major depressive disorder and is widely recognized as a safe, non-invasive treatment. Because of this, most major insurance providers offer coverage when specific criteria are met.
Typical TMS Insurance Requirements
While requirements vary by plan, most insurers ask for:
- A diagnosis of major depressive disorder
- A history of trying multiple antidepressant medications without sufficient relief
- Documentation of therapy participation
- Prior authorization before treatment begins
We break this process down in much more detail in our article, Everything You Need to Know About TMS Insurance Coverage, which can be helpful if you’re early in the process.
Is Spravato (Esketamine) Covered by Insurance in Utah?
Spravato is often covered by insurance, but the approval process is typically more involved.
Spravato is the FDA-approved nasal spray form of esketamine, used specifically for treatment-resistant depression and administered under medical supervision. Because it follows strict FDA and REMS (Risk Evaluation and Mitigation Strategy) guidelines, insurance companies are more likely to cover it than other ketamine options.
What Insurance Companies Look For with Spravato
Coverage usually depends on:
- Diagnosis of treatment-resistant depression
- Failure of multiple antidepressant trials
- Ongoing use of an oral antidepressant alongside Spravato
- Treatment at a REMS-certified clinic
We’ve published several plan-specific guides to help patients understand what coverage looks like with different insurers, including:
- Navigating Spravato Coverage: UnitedHealthcare
- Navigating Spravato Coverage: Aetna
- Navigating Spravato Coverage: Blue Cross Blue Shield, Medicaid, and Medicare
These articles can give you a clearer picture of what to expect based on your specific insurance plan.
Is Ketamine Therapy Covered by Insurance?
IM ketamine therapy is typically not covered by insurance because it’s considered an off-label treatment for depression. Even though there is a growing body of research supporting its effectiveness, most insurance companies reserve coverage for FDA-approved options.
That said, cost should never be the reason someone feels unable to pursue care. At Anew Therapy, we work with CareCredit, which offers financing options that allow patients to spread the cost of treatment over time. For many people, this makes ketamine therapy more accessible and removes the pressure of having to decide between care and affordability.
Many patients still choose ketamine therapy because it offers:
- Rapid symptom relief
- Flexibility in dosing
- Highly personalized treatment plans
If you’re weighing both clinical and financial considerations, we explore these differences in more detail in IM Ketamine vs. Spravato: Which One Is Right for You?
Why Prior Authorization Matters (and Why It’s Not Personal)
If you’ve ever been asked to wait for “prior authorization,” it can feel like a huge barrier, or like someone is scrutinizing you behind the scenes. But prior authorization is just the insurance company’s standard process for confirming that a treatment meets their medical criteria, it’s nothing to sweat over.
This process often includes:
- Clinical notes from your provider
- Medication history
- Diagnostic documentation
At Anew Therapy, our team works directly with insurance companies to submit this information on your behalf. You don’t have to navigate it alone, and you don’t have to have the perfect paperwork yourself.
What If Insurance Denies Coverage?
A denial can feel discouraging, especially when you’re already struggling. But a denial is not always the final answer.
Many denials are overturned through:
- Additional documentation
- Appeals
- Clarifying treatment history
If you’re facing a denial, it doesn’t mean your care isn’t valid. It usually means the insurer needs more information.
Choosing Between TMS, Ketamine, and Spravato
There’s no single “right” choice – only what fits your needs, history, and circumstances.
Some people prioritize insurance coverage and structure. Others prioritize speed of relief or treatment flexibility. Many people simply want to feel like themselves again.
If you’re unsure where to begin, learning about how long treatments last, what results look like, and how they fit into real life can be grounding. Our article Ketamine for Depression: How Long Do the Effects Really Last? is a good place to start.
A Final Word: You Don’t Have to Do This Alone
Reaching out for advanced mental health treatment doesn’t mean you’ve failed. It means you’re listening to yourself and taking your well-being seriously. That takes courage. Research consistently shows that asking for support is not a weakness, but rather a powerful act of resilience.
We also know that insurance can be one of the most stressful parts of this process. The paperwork, the phone calls, the uncertainty, it’s a lot to carry when you’re already dealing with depression or burnout. At Anew Therapy, we have extensive experience working directly with insurance companies, and we handle those conversations on your behalf. You don’t have to figure it out alone, and you don’t have to advocate for yourself when you’re already exhausted.
If you’re ready to explore your options or want help understanding your insurance coverage for TMS, ketamine, or Spravato, our team is here to support you with clarity, compassion, and real guidance every step of the way.To take the next step, call us or text us at (801) 980-2690, or schedule a free consultation online.
Looking for the best full-service mental health clinic in Utah? Anew Therapy works with most insurance plans and supports you throughout your care. Schedule your free intake appointment today.
