Insurance coverage
Blue Cross Blue Shield (all affiliates)
BCBS is a federation of 33+ independent plans. Nearly all of them cover Spravato for treatment-resistant depression; rules vary. A handful - notably BCBS of Massachusetts, Anthem BCBS (CA, CO, CT, GA, IN, KY, ME, MO, NV, NH, NY, OH, VA, WI) and Highmark - cover ketamine infusions under specific medical-necessity criteria. Others reimburse only the professional component while you pay for the drug.
Coverage at a glance
| Modality | Status |
|---|---|
| Spravato (esketamine) | Covered |
| Ketamine IV infusion | Sometimes covered |
| Ketamine IM injection | Sometimes covered |
| Ketamine oral/lozenge | Not covered |
| Psilocybin (Oregon licensed) | Not covered |
| Psilocybin (Colorado licensed) | Not covered |
What the plan requires
- Spravato: 2-trial step therapy, administered at REMS site.
- Ketamine: varies. Anthem and Highmark require TRD documentation plus letter of medical necessity.
- Prior auth required for Spravato across all plans.
Practical tips
- Call the number on the back of your card and ask specifically about J3490 (ketamine) and S0013 (esketamine).
- If your employer is an ASO (self-insured) group, the employer sets the formulary, not BCBS.
- Request a 'pre-determination of benefits' in writing before booking.
Providers accepting Blue Cross Blue Shield
Always confirm in-network status with both the clinic and your plan before your first session.
No verified providers currently list Blue Cross Blue Shield. This can mean the plan is typically self-pay, or that we have not yet surfaced plan acceptance - check back as we expand clinic onboarding.