Ketamine Infusion is a NYC “Game Changer”

How a New Treatment is Changing the Practice of Therapy

SJ
Aug 16, 2018 · 6 min read

Recently, Better has been processing a growing number of claims for ketamine treatments. We spoke with a New York practice, Gateway to Solutions, that is using this innovative treatment for depression. The founder and director of the practice, John P. Carnesecchi, is sharing the Better service with his clients so they can get paid back by their health insurance for this care. Since this is a relatively new treatment, we wanted to learn more about it and how John uses ketamine infusions to help his clients.

John Carnesecchi has always followed his passion. With an undergraduate degree in experimental psychology and a graduate degree in clinical social work, he’s always wanted to help people.

If you help someone and it really rings true for you, go with it. I volunteered in healthcare facilities, hospitals, nursing homes and was part of the 9/11 mental health crisis unit.

He’s been in practice for 20 years and sees his work as humanistic, goal-oriented and evidenced based. His practice uses clinically-proven measures to track progress and understand where the therapy is going.

We don’t provide your traditional school of therapy where someone sits on the couch and gets some gentle nods. We do look at the past to learn a little about a client’s journey but we don’t rest there too long. We’re all about moving forward and providing deeper insights and new coping skills to eliminate negative patterns and develop new ways of thriving emotionally. Everyone who contacts our practice wants to move forward and it’s our job to help that happen.

However, John was aware that talk therapy and pharmacology, the gold standard of mental health treatment, used for patients with depression, anxiety and related mental health conditions, was not always successful. It has an estimated failure rate of around 30 percent. As he says, “30 percent is pretty high,” and he wanted to find alternative treatments when the gold standard failed. The solution he’d been searching for came in the form of a drug called ketamine.

Ketamine is a well-established drug used in emergency rooms, in pediatric care for children with broken bones, and also for burn victims. It also has a alternative history as a psychedelic club and party drug known as Special K. However, as reported by Sara Solovich in the Washington Post, it has recently been found to be very effective in the treatment of moderate to severe anxiety and depression. According to Solovich,

“Experts are calling it the most significant advance in mental health in more than half a century.”

She interviewed Dennis Hartman, a businessman with a history of severe depression verging on suicidal who, as a last resort, agreed to a trial ketamine infusion at the National Institute of Mental Health (NIMH) in Bethesda. One 40-minute infusion changed his life.

“My life will always be divided into the time before that first infusion and the time after,” Hartman says today. “That sense of suffering and pain draining away. I was bewildered by the absence of pain.”

John has seen this reaction from his own patients.

It’s a game changer — a new frontier of mental health care. Research shows that there is something about the metabolism of an infusion and the controlled active ingredient, about how it metabolizes over a 45-minute drip, that helps mental health patients.

Last year, in an NPR article, science journalist, Jon Hamilton reports on the growth of providers offering ketamine infusion as a therapy and developing research in the field that seems to support its success.

“A number of small studies have found that ketamine can do something no other drug can: it often relieves even suicidal depression in a matter of hours in patients who have not responded to other treatments.”

The practice is being fast-tracked by the FDA for approval and is non-addictive since the treatment uses a sub-anesthetic and the frequency of the dosage is spaced over time. According to John, the ketamine infusion allows his patients to benefit from something called neuroplasticity.

Neuroplasticity means making new connections in the brain; generally this is associated with infants as their brains and personalities develop, but now what we’re seeing is that the ketamine combined with cognitive behavioral talk therapy over 12–18 months is helping people make new connections in the brain. It so much more effective in certain cases, the cases in the past you couldn’t move forward or break the cycle of an episode.

John explains that it is often a more successful alternative to electroshock therapy (ECT) for some patients.

When the gold standard of talk therapy and medication doesn’t work, there are various options for a patient. For example, with ECT you’re most often under anesthesia in a hospital setting and there can be side effects. ECT isn’t rapid either. You have to do many sessions and it doesn’t affect neuroplasticity. What is very exciting about ketamine infusion is its rapid response. We usually book a patient for six infusion,. After the first three infusions, we can often break the cycle of a depressive episode. Then we continue with ongoing therapy, in combination with talk therapy, with 12 to 18 months of once–a-month ketamine boosters.

The procedure is very simple. Patients who are treated at John’s practice sit in a darkened room in a lounge chair and wear an eye mask while, unlike many practices, a board-certified anesthesiologist, Dr. John Mendiola, supervises the ketamine infusions. The effect of the infusion is striking.

Our patients tell us how during treatment they get to stand outside themselves, outside of their depression and walk around it. It gives them a break. It’s almost like the muscles in their brain get a break.

In addition, unlike ECT, the recovery time after an infusion is quick. There is a 20-minute supervised recovery period after treatment and then the patient to go back to work.

As John explains, ketamine infusion is effective but can be costly, especially as the treatment is rarely covered in-network by any health insurance plan. However, out-of-network benefits have started to reimburse for this service. Therefore, some of his patients can get paid back by submitting out-of-network claims to their health insurance for reimbursement. That is why John is so enthusiastic about Better.

We introduced Better to our practice a few months ago. Ketamine infusion is not an in-network procedure with any health insurance companies but insurance will reimburse significant portions of the costs using out-of-network benefits. A lot of our patients don’t need the headache of dealing with their health insurance and it is wonderful that Better can help them get paid back. It’s one less thing they have to deal with on their own.

The reaction from his patients who have used Better to file claims has been positive.

We’re getting amazing feedback. Some of our patients are getting paid back $300-$500 per session.

Better, which is free to all providers, also helps to answer insurance questions from his patients so his practice can focus on what matters, delivering care to patients. He gives an example of one patient who got paid back.

She had over 45 claims over the past years and was “so overwhelmed” trying to deal with her health insurance. So I told her about Better. All she had to do was take photos of her claims. She sent off all her claims and told me a week later.

“I love that Better app! I love their service!”

Better would like to thank John P. Carnesecchi for taking the time to talk to us about his psychotherapy and Ketamine Infusion practice. Gateway to Solutions just opened a new downtown office in NYC. You can read a copy of Dr. John Mendiola’s white paper on ketamine infusions here.

If you or your clients have claims for ketamine infusion, our team at Better would be pleased to help. Claims dating back up to two years can be processed, depending on your health insurance plan. If you need Better brochures for your practice, you can request them online or get in touch with your questions at providers@getbetter.co

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SJ

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Helping people get the best possible outcome from their insurance.

Better Blog

Making healthcare simple.

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