Insurance Coverage For Ketamine

1. Does my insurance cover ketamine infusion or KAP treatment for anxiety and depression?

Insurance coverage for ketamine infusion or KAP treatment varies widely. Currently, most insurance plans do not cover the cost of ketamine treatments themselves. 

• However, at Áureo Clinic, partial coverage may be possible if your plan includes naturopathic medical benefits. These benefits often cover the two required 30-minute medical intake appointments and 30-minute ketamine integration sessions following your ketamine treatments (whether IV, oral, or IM).

• The two or three-hour ketamine treatment sessions are as of yet still not covered by insurance.

Cost Comparison: Ketamine Treatment at Áureo Clinic With and Without Insurance Coverage

A. Without Insurance Coverage:

• Medical Intake Appointments:

• 1 x $249 = $249

• Ketamine Treatments:

• 6 x $595 = $3,570

• Integration Appointments:

• 6 x $180 = $1,080

• Total Cost Without Insurance:
  $249 + $3,570 + $1,080 = $4,899

B. With Insurance Coverage:

• Medical Intake Appointments:

• Cost: Only the copay or coinsurance (assuming the deductible has been met if there is one)

• Ketamine Treatments:

• 6 x $595 = $3,570 (no insurance coverage)

• Integration Appointments:

• Cost: Only the copay or coinsurance for each session

• Total Cost With Insurance:

• Medical Intake Appointment: Copay or Coinsurance

• Ketamine Treatments: $3,570

• Integration Appointments: Copay or Coinsurance x 6

Example:

• If Your Copay/Coinsurance Is $30 per Appointment:

• Medical Intake Appointment: 1 x $30 = $30

• Ketamine Treatments: 6 x $595 = $3,570

• Integration Appointments: 6 x $30 = $180

• Total Cost With Insurance:
  $30 + $3,570 + $180 = $3,780

Summary:

• Total Cost Without Insurance: $4,899

• Total Cost With Insurance (Example with $30 Copay): $3,780

With insurance coverage, the total cost could be significantly lower, especially for the medical intake and integration appointments, depending on your specific copay or coinsurance amounts. The savings primarily come from the reduced costs for the intake and integration sessions. However, the ketamine treatments themselves are typically not covered, so the cost remains the same in both scenarios.

2. Which insurance plans is Áureo Clinic in-network with?  Which providers are in-network?

Áureo Clinic is in-network with the following insurance providers for naturopathic medicine:

• Providence Health Plans

• Regence Blue Cross Blue Shield

• Pacific Source

• Aetna

• Cigna

• First Choice Health/Humana

We are also working hard to be able to accept OHP and United Healthcare for our patients as well

Unfortunately, we are unable to accept Moda and Kaiser (the panels are closed to naturopathic providers in Portland at this time)

Which providers are in-network?

• Dr. Lindsay Wilkinson is currently the only provider at the Áureo Clinic who is in-network with medical insurance. 

•  If you are an EXISTING patient and are seeing another provider at Áureo for your ketamine treatments, you can continue to see them for your 2 or 3-hour treatment sessions with ketamine but would be able to see Dr. Lindsay in-person or virtually for integration appointments and follow-up office visits.

If you are a NEW patient and would like to use your insurance benefits to cover a portion of your ketamine treatment, you would be scheduled with Dr. Wilkinson for the medical intake and integration appointments and may be scheduled with one of our other naturopathic providers for your ketamine treatment sessions.  The other providers at Áureo are also Naturopathic Doctors and will collaborate with Dr. Wilkinson to make sure you are receiving the best possible results from your ketamine treatment plan. This allows for the greatest flexibility with scheduling for patients and will allow you to be seen sooner for treatment.

3. What costs will I be responsible for?

Patients who get their office visit portion of ketamine treatment covered by insurance will still be responsible for any copay, coinsurance, or unmet deductible.

• A deductible is the amount the insured person must pay out-of-pocket for healthcare services before your insurance starts to pay. For example, if your deductible is $1,000, you must pay $1,000 before your insurance covers any portion of your healthcare services.  You’ll need to call the customer service number on the back of your insurance card to ask about the total deductible amount and how much has been met for the year (or how much is left to pay).  Typically, the deductible resets every January 1st.

4. How do I know if my insurance will cover these treatments?

It is ultimately your responsibility to understand your benefits and coverage. However, as a courtesy, Áureo Clinic offers a benefits eligibility check. Our administrative team will verify your insurance benefits to help determine if your plan covers the necessary appointments and integration sessions.

• In order to do a benefits verification, please reach out to us via the contact page on our website, the following email address: aureo.office@gmail.com, or via our office phone number 971-220-2169 and our administrative support staff will confidentially gather your information including a picture of your insurance card, the member ID number, and Group ID number.

5. What should I do if I want to explore insurance coverage for ketamine treatment at Áureo Clinic?

You can contact us below and our administrative support staff will confidentially gather your information including a picture of your insurance card, the member ID number, and Group ID number.

6. What happens after I provide my insurance information?

• Once we have your information, we will perform a benefits eligibility check and send you intake paperwork through the patient portal in Charm EHR. It is important that you fill out all required paperwork before your initial visit.

7. What if my insurance does not cover ketamine treatment?

• If your insurance does not cover the treatments, you will be responsible for the full cost of the medical intake appointments and integration appointments as well as the ketamine treatment sessions.  We recommend contacting your insurance provider directly to discuss your coverage options and any potential reimbursement.

• You can use this document to help you get the information you need when you call your insurance company.  

8. How can I contact Áureo Clinic for more information?

• For more details or to start the process, please visit our contact page on the Áureo Clinic website, and our team will be happy to assist you.

9. How can I pay for the cost of ketamine treatments?

We are able to accept cash, check, or credit card at the time of service.  We are also able to accept HSA or FSA funds for ketamine treatments. Additionally, we partner with a service called Cherry to help provide low-cost payment plans for ketamine treatment. 

Low-Cost Payment Plan for Ketamine Treatment with Cherry

At Áureo Clinic, we understand that the cost of ketamine treatment can be significant, so we offer a low-cost payment plan through Cherry to help make your care more affordable. Cherry allows you to split the cost of your treatment into smaller, manageable monthly payments.

How It Works:

1. Apply Online: Visit Cherry's website to complete a quick and easy application. Most patients receive approval in just a few minutes.

2. Choose Your Plan: Once approved, you'll be able to select a payment plan that best suits your budget. Cherry offers flexible options, so you can decide how much you want to pay each month.

3. Start Treatment: With your payment plan in place, you can begin your ketamine treatment at Áureo Clinic without worrying about upfront costs.

Using Cherry makes it easier to focus on your health without the stress of large, upfront payments. For more information, please contact our office or visit our contact page.