Health Net coverage for TMS therapy
We work with Health Net plans for TMS therapy, Spravato, medication management, and psychotherapy. We verify your specific coverage within one business day — before you commit.
Health Net coverage details
Health Net of California offers commercial PPO and HMO plans, Covered California marketplace plans, Medi-Cal managed care, and Medicare Advantage products. Behavioral health benefits are administered through Health Net's behavioral health arm or, for some plans, through MHN (Managed Health Network). Health Net's medical policy framework recognizes Transcranial Magnetic Stimulation as medically necessary for adults with treatment-resistant major depressive disorder who meet defined criteria. The 2024 CMS National Coverage Determination for TMS extended the federal coverage floor to Health Net's Medicare Advantage product line.
What Health Net typically covers
- Adult psychiatry and medication management — evaluations, follow-ups, prescription oversight
- TMS therapy for FDA-cleared indications — MDD/treatment-resistant depression
- Outpatient psychotherapy — individual sessions with in-network behavioral health providers
Medi-Cal managed care members may have different access pathways than commercial members. Some HMO products require referral from a primary care physician before behavioral health services are authorized.
Prior authorization for TMS
A standard TMS course runs 36 sessions over six to nine weeks. Health Net requires prior authorization before the first session, with documentation that typically includes:
- DSM-5 diagnosis of major depressive disorder
- Documented failure of at least two antidepressants at therapeutic dose and duration from at least two pharmacologic classes
- Baseline severity score (PHQ-9, HAM-D, BDI, or equivalent)
- Documented psychotherapy trial or clinical reason it was not pursued
- No contraindications to magnetic stimulation
Our team prepares the packet, routes it to the correct authorizing entity (Health Net direct or MHN), and tracks the determination. Initial decisions typically arrive within 5 to 14 business days; Medi-Cal pathways can run longer.
Verifying your specific plan
Health Net's product mix — commercial PPO/HMO, Covered California, Medi-Cal, and Medicare Advantage — produces very different benefit structures behind the same logo. Session caps, copays, and authorization routing depend on the specific product. Real-time verification against your member ID is the only way to know your coverage.
Verify Your Coverage
Not sure if your plan covers TMS at Healing TMS Clinic?
Send us your insurance card and date of birth via our secure verification form. Our team responds within 1 business day with the exact coverage, prior-authorization requirements, and your estimated out-of-pocket cost.
Other services covered
About Healing TMS Clinic
Healing TMS Clinic is a psychiatric outpatient practice at 5475 East La Palma Avenue, Suite 204, Anaheim, CA 92807. We serve patients throughout Orange County, North Long Beach, the San Gabriel Valley, and the Inland Empire within a 30-mile service radius. Call (657) 656-5611 to begin verification or schedule a clinical consultation.
Other carriers we work with
Find out if TMS is covered for you.
Insurance verification takes about two minutes. We'll tell you whether your plan covers TMS for treatment-resistant depression and what your cost will be — before you book anything.
Monday–Friday, 9:00 AM – 5:00 PM