ivtreatment.advancedpsych - Updated Self-Assessment

1
What type of treatment are you interested in?* This field is required.
TMS
Spravato
IV Treatment (self-pay only)
I'm Not Sure
2
What type of insurance do you have?* This field is required.
Aetna
Blue Cross Blue Shield
Blue Care Network
Optum
United
Cigna
Priority
HAP
Medicare/Advantage Plan
Medicaid
None
3
How many antidepressants have you tried?* This field is required.
0
1
2
3
4
None
4+
4
Have you ever been diagnosed with:* This field is required.
Bipolar 1 with a distinct manic episode
Schizophrenia
Schizoaffective Disorder
None of these
5
You may be a good candidate for treatment at Michigan Advanced Psychiatry!* This field is required.Please provide some basic information, we promise not to share it.
First Name
Last Name
6
Phone Number* This field is required.
Please enter a valid phone number.
7
Email* This field is required.
example@example.com
8
Which location do you prefer?* This field is required.
Ann Arbor, Michigan
Troy, Michigan
Not Sure
9
When is the best time to reach you?* This field is required.
Early Morning
Late Morning
Early Afternoon
Late Afternoon
10
Unique Submission ID
11
Unfortunately, Our Services Are Not Covered By Medicaid.

Spravato treatment is not offered for self-payment due to a high out-of-pocket cost. However, we do offer a self-pay option for TMS! On the next page, click the "Can I still do TMS without insurance coverage?" section to learn more.

If you have any questions or would like to get in contact with our office, please call (734) 436-4886 or send us a message.
12
Insurance Probably Won't Cover Your Treatment

Based on your responses, it is likely that you will not qualify to have your treatment covered by insurance. If you have any questions or would like to get in contact with our office, please call (734) 436-4886 or send us a message.
13
Insurance May Not Cover Your Treatment

Based on your responses, it is likely that you will not qualify to have your treatment covered by insurance. However, TMS or IV Treatment may be a viable solution on a self-pay basis. Please see our FAQ page for more information on self-pay costs. If you have any questions or would like to get in contact with our office, please call (734) 436-4886 or send us a message.
14
If You Haven't Tried Antidepressant Medications

We recommend at least one antidepressant medication trial before seeking alternative treatments such as TMS or IV Therapy. If you have any questions or would like to get in contact with our office, please call (734) 436-4886 or send us a message.
15
Spravato treatment is not offered for self-payment due to a high out-of-pocket cost. However, we do offer a self-pay option for TMS and IV Treatment. Click 'Submit' to learn more about costs associated with these treatments.

If you have any questions or would like to get in contact with our office, please call (734) 436-4886 or send us a message.
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