Quick Answer: Horizon Blue Cross Blue Shield of New Jersey generally covers TMS and Spravato for treatment-resistant depression when medical necessity criteria are met, but does not cover ketamine infusions, which are considered off-label. Elevium Health is in-network with Horizon BCBS of New Jersey, and the billing team runs your benefits check and handles prior authorization before treatment is scheduled — so you'll know what's covered before you commit to anything. If you've reached out about TMS, Spravato, or ketamine and you're covered by Horizon, the next question is almost always the same: what will my plan actually pay for? This post covers where Horizon BCBS of New Jersey typically lands on each treatment, what prior authorization involves, and how Elevium handles the paperwork so you're not the one chasing approvals. First, two things that trip people up "In-network" and "covered" are not the same thing. Elevium being in-network with Horizon means the practice has a contracted relationship with the carrier. Whether a specific treatment is paid for is a separate question that depends on your individual plan and on meeting medical necessity criteria. A treatment can be a covered benefit and still require prior authorization before it starts. Plan details vary, even within Horizon. Horizon administers many plan types — commercial, employer-sponsored, and others — and the specifics (which treatments need authorization, how many medication trials count, what documentation is required) differ between them. Anything below is directional. We confirm the exact terms of your plan at the benefits check. Learn More: Insurance Coverage Does Horizon BCBS of New Jersey cover TMS? For TMS, Horizon generally follows a treatment-resistant depression framework. That typically means a documented diagnosis of major depressive disorder (MDD), a history of antidepressant trials that didn't work well enough or weren't tolerated, and prior authorization before treatment begins. Horizon, like most carriers, also has specific criteria for what counts as an adequate medication trial — duration, dose, and adherence all factor in. TMS for depression is the most commonly covered use. Coverage for TMS for OCD is more variable and tends to require stronger documentation of symptom severity and prior treatment history. If OCD is the reason you're considering TMS, it's worth flagging specifically so we can check that part of your benefits carefully. Does Horizon BCBS of New Jersey cover Spravato? Spravato (esketamine) is FDA-approved for treatment-resistant depression and for major depressive disorder with acute suicidal ideation. Horizon generally covers it, but the prior authorization bar is usually higher than for TMS . Common requirements across plans include a documented MDD diagnosis, a history of failed antidepressant trials, and a concurrent oral antidepressant taken alongside Spravato - that last one is an FDA requirement, not just an insurance rule. Spravato also has to be delivered at a REMS-certified facility, which Elevium is, with a monitoring period after each dose. Where plans differ is in how many prior medication trials they require and how they handle continuation of treatment after the initial phase. Does Horizon BCBS of New Jersey cover ketamine? Generally, no. Ketamine infusion therapy is distinct from Spravato. While Spravato is an FDA-approved esketamine product, IV ketamine for depression is considered off-label, and Horizon — like most carriers — does not cover it. Ketamine at Elevium is a self-pay treatment. If insurance coverage is the deciding factor for you, Spravato is usually the better-covered esketamine option, and it's worth discussing which fits your situation before ruling anything out. You can also review treatment costs to understand the self-pay picture.