Does Blue Shield of California cover ketamine therapy?
Blue Shield of California covers Spravato (esketamine), the FDA-approved nasal spray form of ketamine, for treatment-resistant depression. It doesn't cover IV ketamine infusions. Here's what you need to qualify and how we make getting started easy.
The quick answer
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Spravato (esketamine): covered for adults with treatment-resistant depression who meet Blue Shield of California's requirements.
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IV ketamine infusions: not covered for depression or other mental health conditions. IV ketamine is available at Golden Afternoon as a self-pay treatment.
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Your cost: Most patients with Blue Shield pay $10–$30 per visit once the SPRAVATO withMe savings program is applied.
Spravato vs. IV ketamine coverage
| Treatment | FDA-approved for depression? | Blue Shield of California coverage | Pre-authorization |
|---|---|---|---|
| Spravato (esketamine) nasal spray | Yes, for treatment-resistant depression | Covered | Required — we handle it |
| IV ketamine infusions | No (off-label) | Not covered | N/A — self-pay |
Spravato is esketamine, a form of ketamine that the FDA has approved as a nasal spray for depression. That approval is why insurance covers it while IV ketamine, which is used off-label for depression, isn't covered.
What Blue Shield of California requires for Spravato
Requirements vary by plan, but to approve Spravato Blue Shield of California typically asks that you:
- Be 18 or older with a diagnosis of major depressive disorder.
- Score in the moderate to severe range on the PHQ-9, a short depression questionnaire (a score of 10 or higher). We'll do this with you during your screening.
- Have tried at least two antidepressants from different classes (for example, an SSRI and an SNRI), each at an adequate dose and for long enough to judge whether it worked, without enough improvement.
- Have no medical conditions that rule out Spravato, which Dr. Jenn will review with you.
Not sure if you qualify? That's what the free screening is for.
How it works at Golden Afternoon
Free screening
A short, no-cost call with our team to talk about your history, check your eligibility and verify your Blue Shield of California benefits.
Consultation with Dr. Jenn
A medical consultation with Dr. Jenn, our founder and medical director. It's billed to Blue Shield of California, so you only pay your usual copay or deductible.
We get pre-authorization
Our team submits the paperwork to Blue Shield of California for you and follows up until it's approved. We'll also help you enroll in SPRAVATO withMe so your savings are in place before your first treatment.
Treatment begins
You come in for Spravato sessions in one of our private, calming treatment rooms, with our medical team with you throughout.
Your treatment schedule
Twice a week for the first four weeks, then once a week. Dr. Jenn adjusts the schedule over time based on how you're responding. Plan on a little over two hours per visit, because you stay with us while the effects wear off. Plan a ride home, since you can't drive until the next day.
What Spravato costs with Blue Shield of California
Without help, your share of the cost depends on your deductible and copay, and that can add up during the first weeks of treatment.
SPRAVATO withMe is a savings program from the maker of Spravato for people with commercial insurance like Blue Shield of California. It can cover much of your deductible and out-of-pocket cost for the medication and for each treatment visit. With it, most of our patients pay $10–$30 per visit.
We'll help you enroll and give you a cost estimate after we check your benefits. Program limits apply, and it isn't available for Medicare, Medicaid or other government insurance.
Blue Shield of California vs. Anthem Blue Cross
Blue Shield of California is a separate company from Anthem Blue Cross, with its own coverage policies. Check your insurance card: if it says Blue Shield of California, this is your page. If you have a Blue Shield plan from another state, contact us and we'll check your benefits.
Frequently asked questions
Does Blue Shield of California cover IV ketamine infusions?
No. Blue Shield of California doesn't cover IV ketamine for depression or other mental health conditions, because IV ketamine isn't FDA-approved for those uses. Golden Afternoon offers IV ketamine as a self-pay treatment.
Does Blue Shield of California cover Spravato?
Yes. Blue Shield of California covers Spravato (esketamine) nasal spray for adults with treatment-resistant depression who meet its requirements.
What will Spravato cost me with Blue Shield of California?
It depends on your deductible and copay. With the SPRAVATO withMe savings program, most of our patients with Blue Shield pay $10–$30 per visit. We'll give you an estimate after we check your benefits.
How long does pre-authorization take?
It varies by plan. We submit the request to Blue Shield of California after your consultation with Dr. Jenn and keep you updated until it's approved.
What if I don't meet the requirements yet?
Book a free screening anyway. Dr. Jenn can talk through your options, including what you'd need to qualify and whether self-pay IV ketamine might be right for you.
What happens during a Spravato session?
You give yourself the nasal spray in one of our private treatment rooms while our medical team watches over you. You'll stay with us for at least two hours afterward while the effects wear off. You can't drive until the next day, so plan a ride home.
