Esketamine + TMS Insurance Letter

Dr. Emily Carter Healthcare Service Manager Sunrise Mental Health Clinic 123 Wellness Ave London, UK, SW1A 1AA +44 20 7946 0958 emily.carter@sunrisemhc.co.uk 1 November 2024 Bright Health Insurance 456 Insurance Lane London, UK, SW1A 2BB Re: Request for Coverage of Esketamine and Transcranial Magnetic Stimulation (TMS) Therapy Patient: John Doe Date of Birth: 15 March 1985 Policy Number: 123456789 To Whom It May Concern, I am writing to request insurance coverage for my patient, John Doe, for the use of Esketamine and Transcranial Magnetic Stimulation (TMS) therapy. John Doe has been under my care for 18 months and has been diagnosed with treatment-resistant depression. John Doe has a history of major depressive disorder and has previously undergone cognitive behavioural therapy and medication management with SSRIs and SNRIs, which have not yielded significant improvement. Despite trying multiple treatment modalities, including psychotherapy and pharmacotherapy, John Doe continues to experience significant symptoms that impair their daily functioning and quality of life. Esketamine, a novel treatment for treatment-resistant depression, has shown promising results in clinical trials and is FDA-approved for this indication. Given John Doe's lack of response to conventional treatments, I believe Esketamine offers a viable and necessary option for their condition. The Canadian Network for Mood and Anxiety Treatments (CANMAT) is a network of academic and clinical experts dedicated to improving clinical care for people with mood and anxiety disorders. CANMAT recommends use of racemic Ketamine as a third line treatment option for patients with treatment resistant depression. Please refer to the link; (https://pubmed.ncbi.nlm.nih.gov/33174760/). Additionally, Transcranial Magnetic Stimulation (TMS) therapy has been demonstrated to be effective in patients with treatment-resistant depression. TMS is a non-invasive procedure that uses magnetic fields to stimulate nerve cells in the brain, and it has been shown to improve symptoms in patients who have not responded to other treatments. CANMAT guidelines recommend repetitive Transcranial Magnetic Stimulations (rTMS) as the first line neurostimulation treatment option for patients with treatment resistant depression. I am confident that the combination of Esketamine and TMS therapy will provide John Doe with the best chance of achieving symptom relief and improving their overall mental health. Therefore, I am requesting that Bright Health Insurance approve coverage for these treatments. Cost Esketamine Cost (£500 per session) 1st month – 8 sessions £4000 2nd month – 4 Sessions £2000 3rd, 4th, 5th, and 6th – 8 sessions £4000 The cost for 20 sessions of intranasal Esketamine will be £10,000. rTMS Cost (£150 per session) The cost for 30 sessions of rTMS is £4500. 20 Esketamine treatments (£10,000) + 30 rTMS maintenance treatments (£4500) = £14,500 PROPOSED SCHEDULE Esketamine: Start Date: 1 December 2024 End Date: 1 June 2025 TMS: Start Date: 1 December 2024 End Date: 1 June 2025 Please find attached the relevant clinical documentation, including John Doe's medical history, treatment records, and supporting literature on the efficacy of Esketamine and TMS therapy. Thank you for your consideration of this request. If you require any additional information or have any questions, please do not hesitate to contact me at +44 20 7946 0958 or emily.carter@sunrisemhc.co.uk. Sincerely, Dr. Emily Carter Healthcare Service Manager Sunrise Mental Health Clinic