In Network Insurance Payors

In Network Plans

In Network Plans  - We contract with primary insurance providers across Tennessee to offer care at discounted, pre-negotiated rates:

  • Blue Cross Blue Shield

  • Anthem Blue Cross

  • UnitedHealthcare

  • Optum

  • Cigna

  • Aetna

  • Medicare

  • United Healthcare Student Resources
  • United Healthcare Shared Services
  • UMR
  • Oxford Health United 
  • Golden Rule United
  • Surest United
  • All Savers United 
  • Aetna Meritain 

Billing & Financial Responsibilities

  • No Balance Billing: You are only responsible for your plan's contracted patient costs (copay, coinsurance, and applicable deductible). Our clinicians will never bill you for amounts beyond what your contract specifies.

  • Non-Covered/Emerging Treatments: If your clinician prescribes a newer treatment not currently covered or authorized by your insurance, you can still opt to receive it by signing a financial responsibility authorization.

Verifying Your Benefits

  • Clinician Availability: Nearly all of our physicians and nurse practitioners participate in every listed plan. Please confirm your specific clinician's status with our New Patient Coordinator before your first visit.

  • Check for "Carve-Outs": Always double-check coverage directly with your insurance provider. Certain plans use third-party "carve-out" administrators for behavioral health or specialized services that may not contract with physician groups like ours.

Out of Network Plans

We are an out-of-network provider for any insurance plan not explicitly listed on our In-Network page, including TennCare and the Medicare Advantage plans. Because our clinicians do not hold contracts with out-of-network insurers:

Payment in Full: Full payment is required at the time of service (for example, if a session or treatment is $300, the total $300 is due at your appointment).

Superbills for Reimbursement: Upon request, we will provide an itemized Statement of Service (superbill) that you can submit to your insurance company. Any reimbursement allowed by your policy will be paid directly to you, up to the total amount you paid us.

Special Coverage & Exceptions

Single Case Agreements (SCA): For specialized treatments like Transcranial Magnetic Stimulation (TMS), we can often negotiate a Single Case Agreement with your insurer. If approved, your plan agrees to cover that specific course of treatment at in-network benefit rates.

TRICARE: TRICARE consistently offers strong out-of-network reimbursement when services are properly pre-authorized and approved prior to treatment.

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Insurance Requirements Guideline  to Get Prior Authorization for TMS or Spravato

Disclaimer: Prior authorization criteria, coverage policies, and clinical requirements are set at the sole discretion of each insurance provider and are subject to change without notice. The information provided on this page is intended solely as a general guide and does not guarantee coverage or approval. To determine your specific benefits and receive exact prior authorization guidance for your plan, please schedule a consultation with our office today.
Navigating prior authorization (PA) for Transcranial Magnetic Stimulation (TMS) and Spravato (esketamine) requires proving Treatment-Resistant Depression (TRD) through documented medication trials, clinical evaluations, and structured symptom tracking.
Universal Baseline Clinical Criteria
  • Diagnosis: Severe, recurrent Major Depressive Disorder (MDD) without psychosis. Spravato also covers MDD with acute suicidal ideation.
  • Antidepressant History: Inadequate response to 2 to 4 distinct oral antidepressants from different classes, taken at therapeutic doses for at least 6–8 weeks during the current episode.
  • Psychotherapy: Documented trial of evidence-based therapy (e.g., CBT) or a clinical rationale explaining why therapy was contraindicated or inaccessible.
  • Standardized Scoring: Validated assessment scores reflecting moderate-to-severe depression (e.g., PHQ-9 ≥ 15, MADRS, or HAM-D).
  • Spravato-Specifics: Must be prescribed concurrently with a daily oral antidepressant, administered at a REMS-certified clinic, and include 2-hour post-dose clinical monitoring.
Payer-Specific PA Requirements
Insurance Carrier TMS Medication Trials Spravato Medication Trials Key Payer Nuances
Blue Cross Blue Shield / Anthem 2–4 failed trials + therapy 2+ failed trials + oral AD Criteria vary by state/regional plan; strictly verifies therapeutic dosing and length of previous trials.
UnitedHealthcare / Optum 2–3 failed trials + therapy 2–3 failed trials + oral AD Optum manages behavioral health; requires baseline severity scores and strict progress reviews for re-authorization.
Cigna 2+ failed trials + therapy 2+ failed trials + oral AD Straightforward approvals when medication logs detail exact start/end dates and reasons for discontinuation.
Aetna 2+ failed trials + therapy 2+ failed trials + oral AD Enforces a strict 6-week minimum per medication trial; unmanaged substance use disorders can prompt denials.
Traditional Medicare Local Coverage Determination (LCD) criteria Part B medical necessity Generally does not require upfront PA, but clinical criteria must still be met in medical records to pass audits.
Prior Authorization Checklist for Practice Submissions
  • Psychiatric Evaluation: Detailed diagnostic assessment referencing DSM-5 criteria.
  • Medication History Log: Chronological table listing drug names, maximum daily doses, start/end dates, and reasons for stopping (e.g., lack of efficacy, intolerable side effects).
  • Therapy Documentation: Notes confirming therapeutic modality, duration, and clinical outcome.
  • Rating Scale Results: Recent baseline PHQ-9 or MADRS score completed within 30 days.
  • Facility Certifications: Active REMS certification details (for Spravato submissions).
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Detailed illustration of synaptic connections in the brain for mental health.

Physician Recommended.
Patient Preferred.

  • Dr. Cochran at The Neuroscience and TMS center has served as my psychiatric care physician for the past 5 years. I have made tremendous progress while seeing her. She is attentive, thorough, and professional. I refer her to everyone I know in need of psychiatric care because I trust her and her staff completely. I am very thankful to be a patient of the Neuroscience and TMS center.

    -CL

  • This hands down is the BEST doctor’s office I've ever been to. Not just on a psychiatric level, but just a medical setting in general. I love Dr. Becker and I'm beyond grateful that I found him. He is very personable and just one of the easiest people to talk to. And the front desk is great too and that goes a long way! So yes, 5 stars! I recommend this to anyone who needs to find a good and relaxed environment for psychiatry.

    -MM

  • Mary is wonderful. She understands my medical condition and truly cares. She listens and comforts you in time of need. She is a true human being and doesn’t treat you like a number. She is very professional and knows her stuff.

    -AC

  • Ali was amazing. We have searched for help for years for our son. It was nice for her to listen but then give great advice!! We are in the process of implementing her parenting plan and It is not easy but we can already see a difference!!

    -ER

  • This was a great treatment for me. I have completed TMS therapy numerous times b/c I keep getting better and better. I suffered a traumatic brain injury and was steered towards TMS and it has helped me tremendously…This team knows what they are doing and I’m happy I had the opportunity to do this.

    -JP

  • The staff are 100% committed to the clients’ health and well-being. They find solutions tailored to the individual’s needs and goals. If I could leave 10 stars, I would. ⭐️⭐️⭐️⭐️⭐️⭐️⭐️⭐️⭐️⭐️

    -HH

  • Everyone from Dr. Becker on down has done an outstanding job. Professional and caring that is hard to find in medicine today and you guys provide both!! And, Emily is a real gem as the TMS tech.

    -EPC, MD [VUMC]

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We are here for you.

Want to learn more about one of our treatments or services?
Need to schedule an appointment or have a question about your care plan? We're here for you!

Patient Portal for Current Patients -https://cromwellmedicalintouch.insynchcs.com

 

New Patients or General Inquiry - Call our main office number at 615.224.9800, email us at  support@hopeforyourbrain.com, or complete the form below.

Pharmacies, Clinics, and Insurance - Fax us at (615) 224-9840

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