Ketamine Infusion Out-of-Pocket Estimator

Translate clinic pricing, insurance coverage, and deductible status into a clear budget for ketamine therapy. Enter the per-infusion charge, the number of sessions in your protocol, and the share your plan pays after the deductible. Optional fields let you account for remaining deductible dollars and any HSA/FSA draw so you know the cash you will owe per infusion and overall.

Cash rate or allowed amount billed for each infusion session.
Include the full induction protocol or booster plan you expect to complete.
Percent of eligible charges your insurer pays once the deductible is met.
Defaults to $0. Enter the portion of your deductible still unpaid before treatment.
Add tax-advantaged dollars you intend to use toward the patient responsibility.

Estimates assume the clinic bills one global charge per infusion. Verify eligibility, prior authorization requirements, and payment plans with your provider before scheduling therapy.

Examples

  • $725 per infusion, 6 sessions, 60% coverage, $1,200 deductible, HSA blank ⇒ Total treatment billed: $4,350.00 USD • Patient out-of-pocket before HSA: $2,460.00 USD ($1,200.00 deductible + $1,260.00 coinsurance) • Final patient responsibility: $2,460.00 USD (56.55% of billed) • Insurer pays: $1,890.00 USD (43.45% of billed) • Per-infusion out-of-pocket after HSA: $410.00 USD.
  • $850 per infusion, 8 sessions, 80% coverage, $500 deductible, $2,500 HSA ⇒ Total treatment billed: $6,800.00 USD • Patient out-of-pocket before HSA: $1,760.00 USD ($500.00 deductible + $1,260.00 coinsurance) • HSA/FSA funds applied: $1,760.00 USD • Final patient responsibility: $0.00 USD (0.00% of billed) • Insurer pays: $5,040.00 USD (74.12% of billed) • Per-infusion out-of-pocket after HSA: $0.00 USD.

FAQ

Can I include provider evaluation fees?

Yes. Add intake or follow-up visit costs to the per-infusion charge so they are incorporated into the total billed amount.

What if my insurer reimburses at an out-of-network rate?

Use the plan coverage percentage that applies after deductible for out-of-network ketamine clinics, or reduce it to 0% when only cash payments are allowed.

How do I model copay cards or grants?

Subtract the support amount from your deductible remaining or apply it as part of the HSA/FSA field to reflect third-party assistance covering patient responsibility.

Does the tool handle lifetime infusion caps?

It focuses on the sessions entered. Rerun the calculation if your plan imposes visit caps or switches to cash pay once benefits are exhausted.

Additional Information

  • Most ketamine protocols involve 6–8 infusions over 2–4 weeks; add boosters as separate sessions if needed.
  • If your plan denies coverage, set coverage to 0% so the calculator shows the full cash burden per infusion.
  • Apply any clinic membership fees or anesthesia charges by adding them to the per-infusion price before running the numbers.
  • HSA/FSA draws reduce the final patient responsibility but still represent cash outlay—track remaining balances after each visit.

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