Insurance coverage for Spravato may be better than you expect.
How being out-of-network works in your favor.
In-Network Provider
- Contracted rates with insurer
- Copays and deductibles typically apply
- Insurer controls the fee schedule
- Lower administrative burden
Out-of-Network — PMC
- No contracts — not subject to their fee schedule
- No copays or deductibles for most PPO patients
- Insurance pays based on your out-of-network benefit rate
- We verify your specific benefits in advance
Which plans work with PMC.
We accept:
-
PPO (Preferred Provider Organization) plans — including most commercial PPO plans and many employer-sponsored PPO plans
-
Traditional Medicare plus/with a commercial secondary
-
Union insurance plans with PPO out-of-network benefits — including many first responder, MTA, and municipal employee plans
-
Out-of-network PPO coverage from major carriers — Aetna, UnitedHealthcare, Anthem, BCBS, and others
We do not accept:
-
HMO (Health Maintenance Organization) plans — these restrict patients to in-network providers
-
Medicaid or Medicare Advantage
-
Plans with no out-of-network coverage
-
Cigna
How the verification process works.
- Submit your information Use the 'Check Your Insurance Coverage' form on this page. We need your insurance card details and a brief description of your situation.
- We contact your insurer Our team calls your insurance company and verifies your specific out-of-network benefits for Spravato treatment.
- We follow up with you We contact you directly with a clear explanation of what your plan covers — including any out-of-pocket responsibility.
- You decide With full information in hand, you decide whether to move forward. No pressure. No commitment until you are ready.
Ketamine IV infusion — out-of-pocket.
Questions about whether Spravato or Ketamine IV is right for your situation? Book a consultation and Dr. Rueda will walk you through both options.
Common insurance questions.
If your insurer denies coverage, we discuss alternative options with you — including whether Ketamine IV may be appropriate, or whether a different insurance plan might provide better coverage. We will not proceed with Spravato if coverage is denied without discussing the implications with you first.
No referral is required. You can book a consultation directly. We verify your insurance independently — no referral paperwork needed from your primary care provider.
Yes. When insurance pays an out-of-network claim, it typically shows up on your Explanation of Benefits (EOB) statement. If privacy is a concern, discuss this with our team — we can walk you through what to expect.
The initial consultation fee varies based on your insurance coverage. For patients with PPO insurance, the consultation is often covered. For patients without applicable insurance coverage, a flat consultation fee applies. This is discussed before your appointment is confirmed.
