Denied by NJ Medicaid? We keep going.
NJ Medicaid covers Spravato, and with Medicaid you pay $0 a treatment. Getting there often takes more than one try. Initial denials are common, and we’re incredibly persistent about appealing.
Yes, Medicaid covers Spravato.
- It’s covered. NJ Medicaid (NJ FamilyCare) covers Spravato for adults with depression that hasn’t responded to antidepressants, with a prior authorization first.
- You pay $0. No copay for the medication or the treatment visits.
- We work with the NJ FamilyCare plans: Horizon NJ Health, Aetna Better Health of New Jersey, UnitedHealthcare Community Plan and Wellcare. Whichever one you have, we deal with it directly.
- One exception to know about. Horizon NJ Health’s Spravato policy excludes anyone with a history of bipolar disorder, even when they also have treatment-resistant depression.
- We help with the ride. NJ Medicaid can cover a ride to and from your appointments, and we work with your plan to get you set up with it. You can’t drive yourself home after a dose, so that’s one less thing to arrange.
- No referral needed. You can contact us yourself.
$0 to $40 a treatment
- NJ Medicaid: $0. Initial denials are common, and we’re incredibly persistent about appealing.
- Commercial insurance: up to $40 after Janssen’s SpravatoWithMe program, for patients who are eligible. Your own plan sets the details.
- We check before you commit. Insurance verification starts the moment you reach out.
A denial from a Medicaid plan is common, and usually not the last word.
Medicaid plans review Spravato requests closely, and many people are turned down on the first request. That isn’t a judgment that you don’t qualify. It’s usually a request for more paperwork, applied strictly.
That’s the point where a lot of people are told “sorry, your insurance won’t cover it” and stop. We don’t. We appeal the denial, then appeal again at the next level, and then ask for an independent external review outside the plan. Across all insurers, in our most recent internal review, 34 of 36 denials were overturned.
While an appeal is in progress, we keep you posted. You won’t be left wondering whether anyone is working on it.
On NJ FamilyCare? Check your coverage. You’d pay $0.
Send your name, date of birth and plan. We check it, start the approval, and handle any appeal if the first answer is no.
Name, date of birth and insurer. We check your plan and call you back. No commitment.
Check my coverageRegister once, and our team starts your insurance check and reaches out to schedule your evaluation.
Request an evaluationFrom first call to first treatment, with Medicaid.
- You send the formHave your NJ FamilyCare card handy if you can.
- Your evaluationUsually within one business day of your first call.
- We request approvalWe submit the prior authorization to your Medicaid plan and follow it up.
- If it’s denied, we appealThrough each level, up to an independent external review.
- We set up your rideWe work with your plan to arrange insurance-covered transportation, so getting to and from your visits isn’t a worry.
- Your first treatmentAs soon as the approval comes through, at $0 to you.
Bring us the letter.
If a Medicaid plan has already denied you Spravato, through another office or on an earlier request, call us. Send the denial letter if you have it, and we’ll tell you what can be done.
What Medicaid members ask us.
Is Spravato covered by Medicaid in New Jersey?
Yes. NJ Medicaid (NJ FamilyCare) covers Spravato for treatment-resistant depression with a prior authorization, and patients pay $0.
Is esketamine covered by Medicaid?
Yes. Esketamine is the medication in Spravato, and NJ Medicaid covers it in the same way, with a prior authorization.
My Medicaid plan denied Spravato. What now?
Call us. Initial denials are common with Medicaid plans, and we’re incredibly persistent about appealing, through each level and up to an independent external review. In our most recent internal review, 34 of 36 denials were overturned.
Which NJ Medicaid plans do you work with?
Horizon NJ Health, Aetna Better Health of New Jersey, UnitedHealthcare Community Plan and Wellcare. With any of them, patients pay $0.
Does Horizon NJ Health cover Spravato?
Yes, with a prior authorization, and initial denials are common, so expect us to appeal. One firm exception: Horizon NJ Health’s policy excludes Spravato for anyone with a history of bipolar disorder, even alongside treatment-resistant depression.
Does Medicaid cover a ride to my treatments?
NJ Medicaid can cover transportation to your appointments, and we work with your plan to get you set up with it. You can’t drive yourself home after a dose, so it’s worth arranging before your first visit. Ask us when you call.
Will I have to pay anything with Medicaid?
No. With NJ Medicaid, your treatments cost you $0.