You're likely losing tens of thousands of dollars, per physician in your practice¹—and most of it isn't showing up on any financial statement.

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That's the cost of prior authorization in psychiatry today. While you're focused on patient care, insurance companies are quietly bleeding your practice dry through administrative burdens that hit psychiatric practices harder than any other specialty. And if you're offering or considering Spravato or TMS? The numbers get even worse.

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After working with over 1,000 psychiatric practices and digging into the latest 2024-2025 industry research, we've uncovered devastating financial reality that most practice owners don't see until it's too late. Let's pull back the curtain on what prior authorization is really costing you and your patients—and more importantly, what you can do about it.

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What is Prior Authorization in Psychiatry?

You already know the basics: Prior authorization is the insurance company's requirement that you prove your patient needs the treatment before they'll pay for it. Psychiatry gets hammered worse than any other specialty.

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While other medical specialties deal with prior authorization for 30.7% of their services, psychiatric services require authorization 57% of the time².  That's nearly double the administrative burden, right off the bat.

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Relief May Be Coming... But Not Soon Enough: HHS Promise to Streamline Prior Authorization

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Recent Policy Announcements
‍On June 23rd, 2025, HHS Secretary Kennedy and CMS Administrator Dr. Oz announced that major insurers—including Aetna, Blue Cross Blue Shield, Cigna, Humana, and UnitedHealthcare—have pledged to fix the broken prior authorization system.

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Additionally, Health and Human Services Secretary Robert F. Kennedy Jr. recently announced plans to eliminate prior authorization requirements, with Medicare, Medicaid, and other insurance payers expected to comply by the end of the year.

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What This Actually Means for Psychiatric Practices

‍While these announcements sound promising, we've heard similar promises before. Based on historical insurance patterns and the complexity of psychiatric care, providers should prepare for:

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• Increased documentation requests from insurance companies
• Enhanced claims processing requirements, including unsolicited claims attachments
• More frequent claim denials citing insufficient medical necessity documentation
• Payment delays due to expanded denial and appeal processes
• Potential audit activity and recoupment requests in future years

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The impact on specialized services like Spravato, TMS, and out-of-network reimbursement is still being determined, and the timeline stretches into 2026-2027.

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The timeline for meaningful change stretches into 2026-2027, and the administrative burden isn't disappearing overnight—it's likely shifting into different forms of documentation requirements and compliance hurdles.

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Smart practices aren't waiting around to find out if these reforms will actually materialize. Your patients need help today. Don't navigate these changes alone. Let Osmind's team of psychiatric practice experts help you prepare for what's coming. Schedule a consultation today.

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How Long Does Prior Authorization Take for Medication? For Spravato and TMS?

For standard psychiatric medications, you're looking at 2-3 days, with complex treatments like TMS and Spravato taking up to 14 days³. In a field where treatment adjustments can mean the difference between stability and crisis, every day matters.

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The True Cost of Prior Auths Is Worse Than You Think

The daily reality for psychiatric practices: While you might run 20 benefits verifications daily to check patient coverage, you're typically processing 1-2 medication prior auths that require detailed documentation and approval. Each PA consumes 30-45 minutes of staff time, and for practices offering Spravato, add reauthorizations every 3-6 months per patient.

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What if I’m a solo provider? Or a larger practice?

The cruel irony? Solo practitioners—who can least afford it—often face the highest per-physician burden because they lack economies of scale. Large practices face renewed complexity managing PA across multiple sites and payer contracts.

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Whether you're solo or multi-site, the operational burden scales with your patient volume, but the fundamental problem remains the same: psychiatric PAs require specialized knowledge that generic solutions can't provide. Most practices try to solve this by hiring help—which is where the real problems begin (scroll down for solutions).

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The Spravato and TMS Prior Authorization Nightmare

If you're offering or considering interventional treatments, brace yourself. The documentation burden becomes a labyrinth of codes, REMS, and PAs.

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For Spravato:

• REMS certification requirements create dual documentation—both for safety compliance AND prior authorization¹⁰
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• Despite claims of reduced requirements, UnitedHealthcare still requires failure of at least 2 antidepressants for minimum 8 weeks each¹¹
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• Processing takes 5-7 days minimum, with frequent requests for additional clinical documentation
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• Cost without authorization: $590-$885 per dose, potentially $49,200 annually¹². That’s just the cost of the drug, not including the unpaid time it costs for the physician to do an office visit.

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For TMS:

• Processing delays stretch 7-21 days depending on insurer¹⁴
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• Reauthorization required after 20-25 sessions, causing treatment gaps in 15-25% of patients¹⁵
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• Documentation must prove 2-4 failed antidepressant trials, sometimes medication augmentation trials and psychotherapy trials with research-grade specificity
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The Patient Abandonment Crisis From Mismanaged Prior Auths

78-82% of psychiatric patients abandon treatment due to prior authorization barriers¹⁶.

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Compare that to the baseline 25% dropout rate in mental health services, and you realize prior authorization more than triples the likelihood your patients won't get the help they need.

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The ripple effects are devestating:

• 24% of physicians report prior authorization led to serious adverse events in their patients¹⁷
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• Patients frequently end up in emergency departments when psychiatric medications are delayed¹⁸
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• Treatment interruptions lead to symptom deterioration and potential crisis situations¹⁹
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You didn't become a psychiatrist to watch patients deteriorate while insurance companies deliberate. Yet that's exactly what's happening in practices across the country every single day.

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Should You Hire a Prior Authorization Specialist?

Looking at those numbers, most practice owners think: "I'll just solve this by hiring staff or using a billing company." Here's why that approach consistently fails and costs even more:

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"We'll Handle It Internally"

Your clinical staff didn't train to become insurance specialists. Every hour they spend on prior auths is an hour not spent on patient care, creating a vicious cycle where patient care suffers while administrative burden grows. Without specialized psychiatric billing knowledge, your approval rates suffer and appeal success rates drop.

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"We'll Hire Someone to Handle PAs"

‍You've added $48,000-$60,000 to your annual overhead for someone who will likely burn out within 18 months. Here's what actually happens:
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• High burnout rates for psychiatric PA specialists due to the emotional toll of constant denials combined with pressure knowing patients are deteriorating while waiting for approvals
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• $12,000-15,000 replacement and retraining costs every time they quit
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• Lower approval rates from general PA staff vs. psychiatric specialists who understand the complexity
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• Hidden knowledge gaps that cause preventable denials and patient abandonment
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• You still need backup coverage, training systems, and management oversight
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The math gets worse, not better. Hiring a $48,000 PA specialist who achieves suboptimal approval rates means tens of thousands in additional lost revenue annually. Staff turnover and replacement costs hit $15,000+ per replacement cycle plus months of suboptimal performance during ramp-up.
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"Our Billing Company Handles It"

‍Generic billing companies treat psychiatric PAs like any other medical PA. They don't understand that psychiatric medications have limited alternatives, treatment delays cause rapid deterioration, and Spravato/TMS require specialized psychiatric documentation that differs fundamentally from med management. You end up needing internal staff for complex cases anyway.
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Lack of specialized knowledge leads to lower approval rates, longer delays, and more abandoned treatments.
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What Actually Works: Partner with Osmind for all-in-one specialized billing, prior auths, and psychiatry EHR
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Every minute you spend fighting with insurance companies or submitting REMS documentation is a minute you're not spending with patients.
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As you know all too well, with treatments like Spravato, TMS, and ketamine transforming psychiatric care, practice operations have become incredibly demanding. Without specialized expertise:

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• 15% of your revenue disappears in denied claims
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• Patients drop out while waiting for authorizations
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• Disconnected systems leak money at every step
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• You burn out on administrative tasks instead of patient care
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After serving 1,000+ forward-thinking psychiatry practices and seeing what drives success or failure, Osmind has built a playbook to help practices thrive.

With Osmind 360, you get the Osmind EHR, billing, prior auths, and practice services all in one simple package priced as a percentage of collections. We only succeed when you succeed.
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What This Means for Your Practice:

• 95%+ net collection rates — 10% higher than the industry average
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• Dedicated psychiatric billing team handles everything from prior authorizations to denials management
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• Psychiatry-tailored workflows save you over an hour daily
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• Automated REMS submission for Spravato can save you $12,000 annually
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• 7-day prior auth turnaround on average across payers by specialists who understand complex psychiatric treatments
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"Other vendors weren't as robust as you. That's why you're in the lead right now." - Psychiatry Practice Owner
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What sets Osmind apart? Our technology and services reflect the knowledge of pioneers who've delivered 100,000+ TMS and Spravato treatments. We’ve built a playbook to serve forward-thinking practices like yours.
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Take the Next Step: Build Your Dream Practice with Osmind

Every day you operate without specialized psychiatric practice management, you're losing revenue while burning out on administrative tasks that pull you away from patient care.
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Prior auths are only getting more complex, but you don’t have to fly solo.
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Ready to make more money, save time, and provide better care? Schedule a consultation with Osmind today.

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Let's build your dream practice together.

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References

1) American Medical Association. 2024 AMA Prior Authorization Physician Survey. Accessed December 2024. https://www.ama-assn.org/system/files/prior-authorization-survey.pdf

2) Kaiser Family Foundation. Mental Health and Substance Use Disorder Coverage in Medicare Advantage Plans. December 2024. https://www.kff.org/mental-health/issue-brief/mental-health-and-substance-use-disorder-coverage-in-medicare-advantage-plans/

3) FC Billing. Insurance Coverage for TMS and Spravato: 2025 Guide. Accessed December 2024. https://myfcbilling.com/insurance-coverage-for-tms-and-spravato/

4) American College of Physicians. Toolkit: Addressing the Administrative Burden of Prior Authorization. Updated 2024. https://www.acponline.org/advocacy/state-health-policy/toolkit-addressing-the-administrative-burden-of-prior-authorization

5) American Medical Association. Fixing prior auth: Nearly 40 prior authorizations a week is way too many. June 2024. https://www.ama-assn.org/practice-management/prior-authorization/fixing-prior-auth-nearly-40-prior-authorizations-week-way

6) Medical Economics. Prior authorization: How it evolved, why it burdens physicians and patients, and the promise of AI. April 2025. https://www.medicaleconomics.com/view/prior-authorization-history-burden-ai-future

7) Psychology Today. Prior Authorization: A Barrier to Mental Health Recovery. January 2024. https://www.psychologytoday.com/us/blog/beyond-mental-health/202401/prior-authorization-a-barrier-to-mental-health-recovery

8) American Medical Association. Advocacy in action: Fixing prior authorization. Updated 2024. https://www.ama-assn.org/practice-management/prior-authorization/advocacy-action-fixing-prior-authorization

9) Zippia. Prior Authorization Specialist Salary (June 2025). https://www.zippia.com/salaries/prior-authorization-specialist/‍

10) SPRAVATO REMS Program. Risk Evaluation and Mitigation Strategy. Accessed December 2024. https://www.spravatorems.com/

11) UnitedHealthcare. Prior Authorization Medical Necessity - Spravato. Updated 2024. https://www.uhcprovider.com/content/dam/provider/docs/public/prior-auth/drugs-pharmacy/commercial/r-z/PA-Med-Nec-Spravato.pdf

12) Reuters. J&J prices ketamine-like depression treatment at $590-$885 for two doses. March 2019. https://www.reuters.com/article/us-johnson-johnson-fda-pricing-idUSKCN1QN2AX/

13) Boulder TMS. Is TMS Covered by Insurance? TMS Pricing Guide (2024). https://www.bouldertms.com/tms-pricing-guide

14) Madison Avenue TMS. Does medicare cover TMS Therapy? Accessed December 2024. https://www.madisonavetms.com/blog/will-medicare-cover-tms-therapy/

15) American Medical Association. Exhausted by prior auth, many patients abandon care: AMA survey. June 2024. https://www.ama-assn.org/practice-management/prior-authorization/exhausted-prior-auth-many-patients-abandon-care-ama-survey

16) American Medical Association. Prior authorization delays care—and increases health care costs. Updated 2024. https://www.ama-assn.org/practice-management/prior-authorization/prior-authorization-delays-care-and-increases-health-care

17) Cellarian. Prior Authorization Delays Care — And Increases Health Care Costs. 2024. https://www.cellarian.com/blog/prior-authorization-delays-care-and-increases-health-care-costs

18) American Journal of Managed Care. Prior Authorizations and the Adverse Impact on Continuity of Care. April 2025. https://www.ajmc.com/view/prior-authorizations-and-the-adverse-impact-on-continuity-of-care

19) McKinsey & Company. AI ushers in next-gen prior authorization in healthcare. Updated 2024. https://www.mckinsey.com/industries/healthcare/our-insights/ai-ushers-in-next-gen-prior-authorization-in-healthcare

20) Conifer Health Solutions. Five Benefits of Automation in Boosting Authorization Efficiency. 2024. https://www.coniferhealth.com/knowledge-center/five-benefits-of-automation-in-boosting-authorization-efficiency/

21) UnitedHealthcare. How the UnitedHealthcare Gold Card program helps modernize prior authorization. October 2024. https://www.uhc.com/news-articles/newsroom/gold-card

22) Academic.oup.com. Perceptions of prior authorization burden and solutions. Health Affairs Scholar, September 2024. https://academic.oup.com/healthaffairsscholar/article/2/9/qxae096/7727862

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