CONSULTATION PROCESS

To be eligible for Spravato (esketamine) or ketamine treatment through Zen Psychiatric Services, all incoming patients must be referred by a physician or attending psychiatrist. Initial psychiatric evaluations are one hour in length and will focus on symptoms and treatment history. We welcome referrals solely for evaluation and are happy to serve as a psychiatric consultation resource for our colleagues in the community. Initial evaluations are billed at $150.

If a client is not considered appropriate for ketamine or esketamine treatment, Zen Psychiatric will discuss other treatment recommendations with the client and will provide a copy of the completed intake evaluation to them and the referring provider within five (5) business days. As noted earlier, Zen Psychiatric WILL NOT accept patients for ongoing general psychiatric care. Referral to Zen Psychiatric does not constitute referral for ongoing general psychiatric care.

If a client is considered appropriate for treatment, and insured, Zen Psychiatric will seek prior authorization to use esketamine (Spravato) nasal spray. If prior authorization is approved, out of pocket cost is typically the client’s specialist copay.  Sometimes it is a larger sum, up to the value of the annual deductible on the health insurance policy.  The recommended course of treatment is twice weekly for four weeks, followed by once weekly for four more weeks, then either stopping or continuing as clinically indicated. (At time of this writing Zen Psychiatric does have patients on maintenance – some weekly, some every other week, some monthly.  However, the majority of patients have completely stopped treatment after the standard course of 14 sessions over 12 weeks.)

If a client is not insured or wishes to self-pay for purposes of privacy, they can elect to receive intramuscular ketamine injections. The treatment schedule and protocol are the same as for esketamine  – twice weekly for a month, followed by weekly for a month, followed by discontinuation or further maintenance depending on clinical status. Cost for those treatments must be paid in full by the patient.

TREATMENT PROCESS

All Zen Psychiatric Services clients treated with ketamine or esketamine are required to have a driver to and from treatment. Clients must take no oral food for at least two hours prior to treatment. They remain under close observation of Zen Psychiatric staff for at least 120 minutes, during which time they have their vital signs checked at least three times: before, once during, and then after treatment. The most common reported (but infrequent) side-effects during treatment are nausea, transient increases in blood pressure, and dissociation. Supportive medications to manage those side-effects are available on site and will be administered as needed by trained staff, without any extra cost to the client.

The need for observation and possible management of side-effects is the primary driver behind the cost of treatment with ketamine, and a very significant factor in the cost of treatment with esketamine. Neither ketamine or esketamine are available for unsupervised self-administration. To maximize benefit, treatments are best administered on a Monday/Thursday or Tuesday/Friday schedule.

The treatments are administered in recliners stationed within visually private treatment bays. Each treatment bay is equipped with a small nightstand on which there are cell phone charging cords, white noise machines, and a lamp. Blankets and handheld fans are available on request. There is WiFi guest access. Toward the end of the session, clients receive a small snack and something to drink. No last names or identifying information are ever spoken out loud. (There is an opportunity for fully private sessions, potentially in the presence of the client’s therapist, in one of two offices on premises. Such inquiries are welcome!)