SPRAVATO^®

Most commercial insurance carriers and Medicare cover the cost of Spravato (aside from any copays or deductibles) for patients who meet their criteria. We do a benefits investigation to determine if you will qualify if Spravato is recommended after an initial consultation. To learn more about insurance coverage for Spravato and other resources, please call a Janssen CarePath Care Coordinator at (844) 777-2828 or visit janssencarepath.com.

Since we have clinicians who are in-network with Cigna, United and Medicare, we are usually able to get office visits covered for patients with these insurances. Office visits may not be covered for patients with out-of-network plans but you can submit the claim for out-of-network reimbursement if your plan offers this (e.g. a PPO plan).

For individuals whose insurance are in-network at Curated, the cost of each appointment would be the same as a typical office copay for your plan, so long as you’ve met your plans deductible or coinsurance requirements. We recommend that you contact your insurance plan and verify your benefits coverage and out of pocket costs.

For individuals on insurance plans that are out-of-network, we must follow the same FDA mandates which dictates a two hour treatment time which includes a check-in with a psychiatrist or psychiatric nurse practitioner before beginning treatment each day followed by observation time supervised by one of our facilitators. The charge for time with the psychiatrist or psychiatric nurse practitioner and subsequent observation by the facilitator is typically $550 if paying privately but can vary based on which prescribing practitioner is involved. Please note if the doctor, nurse or other healthcare professional is needed to stay beyond this timeframe out of clinical necessity, this cost could increase.

If you have out-of-network benefits, you may be able to receive reimbursement for the office visit. The codes to inquire about include 99212, 99215, 99417, 99415, and 99416. Check with your insurance plan!

If Spravato is not covered by your insurance, we recommend exploring IV ketamine infusions as a more cost-effective alternative. We recommend Ember Health as a practice in NY offering Ketamine infusions that works collaboratively with the mental health professionals on your team. If you are interested in paying privately for the Spravato, the cost can vary depending on the market rate at the time and dosage but is typically between $1,450-$1,650 per medication and observation hours.

Unfortunately, we do not typically offer financial hardships or single case agreements for Spravato treatment. This treatment protocol is expensive, highly regulated and resource-intensive which prevents us from offering these services on a reduced fee basis. We have unfortunately found that single case agreements are not reliably paying and honoring the agreements and, as a result, are not open to them for Spravato treatment at this time. There may be rare exceptions for people who have what is called a self-funded plan through their employer but the rates offered for the visits and the drug itself must be transparently shared with us and reasonable.

Generally, before starting Spravato, Curated begins with a comprehensive assessment. These range between 1-2 hours, typically. Rarely, sometimes they may take longer.

After the initial consultation, Spravato appointments are twice a week for at least 2 hours for the first month. They can be longer if patients are not ready to leave after 2 hours, however. This happens rarely but we must use our clinical judgment when making decisions about ending the sessions. During the second month, appointments are scaled back to once a week. After 2 months, whether or not to continue and at what frequency depends on clinical necessity and insurance coverage beyond the 2 month window. This can vary widely from plan to plan.

Everyone’s experience with Spravato is a little different. Some people feel tired and relaxed during the sessions whereas others may have unusual perceptual experiences and dissociative feelings. It is common to feel shifts in one’s perspective and feelings of connectedness to others and the world around them.