Insurance Coverage
Coverage for VNS Therapy for the adjunctive long-term treatment of chronic or recurrent depression for patients over the age of 18 who are experiencing a major depressive episode and have not had an adequate response to four or more adequate antidepressant treatments is likely to be based on each individual's unique clinical circumstances until payers have an opportunity to implement formal policy. Case-by-case approvals have been obtained from more than 300 different payers since FDA approval in July 2005. 

Several appeals steps may be required in order to gain coverage for VNS Therapy in TRD, and the process and number of steps vary from state to state and from plan to plan.  A Regional Case Manager can help you determine if specific insurance plans may cover aspects of the VNS Therapy procedure by verifying patient benefits and determining the best way to pursue approval.  While each health plan is different, it will most likely be very helpful for you to obtain pharmacy records and explanation of benefits related to treatments you have experienced for depression in the past, including electroconvulsive therapy (ECT), if applicable. Information related to hospitalizations you may have experienced for depression may also be very helpful to your psychiatrist in preparing your letter of medical necessity.

Please contact a Regional Case Manager at 1-877-NOW-4VNS (1-877-669-4867).