TMS (transcranial magnetic stimulation) denied by insurance — how to appeal

About TMS (transcranial magnetic stimulation)

TMS denials almost always involve treatment-resistant depression criteria. Most commercial plans cover TMS when the patient has tried (and not adequately responded to) at least two antidepressants of different classes at therapeutic doses for adequate trial durations. The appeal should document each prior trial with dates, doses, durations, and outcomes.

Common reasons TMS (transcranial magnetic stimulation) gets denied

• Treatment-resistant depression criteria not met
• Insufficient documentation of prior antidepressant trials
• Plan considers TMS experimental for the indication
• Prior authorization not in place

Evidence that helps overturn a TMS (transcranial magnetic stimulation) denial

• Psychiatrist's letter documenting prior antidepressant trials and treatment response
• FDA labeling for TMS
• Clinical practice guidelines (APA)
• Documentation of severity (PHQ-9 scores, functional impairment)

Recommended approach

For most TMS (transcranial magnetic stimulation) denials, our triage will recommend the Premium Appeal ($499) tier. We prepare a professionally-structured appeal that addresses the specific denial reason, cites the relevant clinical evidence, and meets your insurer’s appeal-rights deadlines. Treatment cost exposure: typically $6,000–$12,000 for a treatment course.

What to do next

1. Find your denial letter (or EOB) and check the appeal deadline.
2. Upload it to InsureDefense for a free triage — no payment required to see the assessment.
3. If you choose to proceed, you’ll receive a draft within 24 hours (12 hours for urgent cases).
4. Submit the appeal to your insurer using the fax / portal / mailing address we provide.
5. Track the insurer’s response using our 14/30/45-day follow-up reminders.

Upload your TMS (transcranial magnetic stimulation) denial See pricing