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Neurofeedback is fast becoming a well-known mental health treatment in the U.S. There were already more than 7,500 mental health professionals offering this service back in 2016, according to one estimate.
But with the increasing popularity and availability, many interested in neurofeedback are asking: is it covered by insurance?
To answer this question, we've consulted with Sean Brock, an LPC and BCN in Denver, Colorado, who owns and operates Neuro Colorado, a psychotherapy practice that integrates Neurofeedback. His insights provide a realistic view of the current insurance landscape for neurofeedback.
The insurance landscape for neurofeedback is, to put it mildly, a mixed bag.Â
"The hard truth is that there are no major private insurance companies in Colorado (or the rest of the country, as far as I know) that regularly reimburse for neurofeedback," Sean said.
While some insurance companies have begun to recognize the potential benefits of neurofeedback for certain conditions, many still consider it an experimental or investigational treatment.
Several factors influence whether an insurance company will cover neurofeedback:
It's worth noting that even when insurers do cover neurofeedback, they often have strict criteria for approval, such as requiring that other conventional treatments have been tried first.
It's important to note that coverage can vary significantly by state. Always check your state regulations to ensure compliance.
Now let’s look at a few common ways people may try to access Neurofeedback therapy.
Medicare, the federal health insurance program for people 65 and older, generally does not cover neurofeedback. However, there are exceptions.
For example, Medicare may cover neurofeedback when it's used as part of a comprehensive treatment plan for stroke rehabilitation.
Medicaid coverage, on the other hand, varies by state. According to Brock, "Medicaid is the one major insurance that reimburses for Neurofeedback, although it's not clear which specific code they support."
Some state Medicaid programs have begun to cover neurofeedback for certain conditions, particularly for children with ADHD or autism spectrum disorders.
It's essential to check with your state's Medicaid office for specific coverage details.
In some cases, workers' compensation insurance may cover neurofeedback.
This is typically seen in cases where an employee has suffered a traumatic brain injury or is dealing with chronic pain as a result of a workplace injury.
The coverage often depends on the recommendation of the treating physician and the specific workers' compensation policies in your state.
For instance, a worker who developed chronic migraines after a head injury on the job might be approved for neurofeedback sessions if other treatments haven't provided sufficient relief.
Brock notes, "We have received payment for PTSD diagnoses for some police officers as well as payment for those suffering from mild Traumatic Brain Injuries."
When it comes to insurance coverage, the specific condition being treated plays a crucial role. Here's a breakdown of some conditions where you might have a better chance of getting coverage:
The FDA has cleared certain neurofeedback devices for relaxation training and stress reduction. While this doesn't guarantee insurance coverage, it does lend credibility to the treatment in these areas.
Many uses of neurofeedback are considered "off-label," meaning the FDA does not specifically approve them for that purpose.
However, insurance may still cover these uses if there's sufficient evidence of efficacy. Some conditions that fall into this category include:
It's important to note that even for these conditions, coverage is not guaranteed.
Your healthcare provider may need to demonstrate that other treatments have been ineffective before insurance will consider covering neurofeedback.
If you're considering neurofeedback and want to explore insurance coverage, here are some steps to follow:
Remember, insurance companies often use specific codes for billing purposes. For neurofeedback, there are three appropriate CPT codes:
Knowing these codes can help you discuss coverage more precisely with your insurance provider.
If you find that your insurance won't cover neurofeedback, you're not out of options:
Many neurofeedback providers offer package deals or sliding scale fees for patients paying out of pocket.
While it can be a significant investment, some people find the potential benefits worth the cost.
A typical course of neurofeedback treatment might involve 20-40 sessions, with costs ranging from $50 to $200 per session.
That means the most you’ll pay is in the $8,000 range. Well worth it for improved mental health, though not the most accessible treatment.
Some neurofeedback clinics offer financial assistance or payment plans.
It's worth asking about these options if cost is a barrier.
Additionally, you might explore whether you can use funds from a Health Savings Account (HSA) or Flexible Spending Account (FSA) for neurofeedback treatments.
As Brock points out, "Although this is not a huge advantage, it is an income tax-free way to pay for treatment."
If neurofeedback is financially out of reach, consider exploring other evidence-based treatments for your condition.
For example, cognitive-behavioral therapy (CBT) is widely covered by insurance and has proven effective for many conditions that neurofeedback also addresses.
The field of neurofeedback is continuously evolving, and with it, the insurance landscape:
Numerous studies are underway to further validate the effectiveness of neurofeedback for various conditions.
As more evidence accumulates, insurance companies may become more willing to cover these treatments.
Keep an eye on reputable medical journals and organizations like the International Society for Neuroregulation and Research (ISNR) for the latest findings.
To address some common queries about neurofeedback and insurance coverage, we've compiled the following FAQs:
As of 2024, the FDA has not explicitly "approved" neurofeedback for treating specific conditions.
However, it has cleared certain neurofeedback devices for particular uses:
It's important to note that FDA clearance is different from FDA approval.
Clearance means the FDA has determined that the device is substantially equivalent to another legally marketed device.
Many neurofeedback applications are considered "off-label" use, meaning they're used for purposes not specifically cleared by the FDA.
This question is similar to the first FAQ, but here are some additional tips:
Remember, insurance policies and coverage can change, so it's always best to check directly with your insurance provider for the most up-to-date information on biofeedback coverage.
While navigating insurance coverage for neurofeedback can be challenging, it's not impossible.
As research continues to demonstrate the efficacy of neurofeedback for various conditions, insurance policies are likely to evolve.
In the meantime, being well-informed and prepared to advocate for your health needs is crucial.
Remember:
For those interested in advocating for neurofeedback coverage, the ISNR provides a toolkit with pre-written letters and research studies to support individuals attempting to petition their insurance company to cover neurofeedback for ADHD treatment.
This resource may also be helpful for petitioning coverage for other symptoms.
Ultimately, your mental health is worth the time, money, and energy it takes to improve it. Whether or not Neurofeedback is part of your path, keep fighting and advocating for yourself.
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This blog post is provided for informational purposes only and is not intended as legal, business, medical, or insurance advice. Laws relating to health insurance and coverage are complex, and their application can vary widely depending on individual circumstances and state laws. Similarly, decisions regarding mental health care should be made with the guidance of qualified health care providers. We strongly recommend consulting with a qualified attorney or legal advisor, insurance representative, and/or medical professional to discuss your specific situation and how the laws apply to you or your situation.
