"I do not want another pill." It is one of the most common things people with long-running depression think and one of the least common things they say out loud in the exam room. If you are in St. Louis, carry a work or marketplace plan, and have reached that point, this script is built to help you say it clearly, ask about drug-free options including TMS, and leave with a plan your insurer will actually approve.
Why the script starts with you
In June, a survey our publisher paid for put two linked questions to 443 adults in ten Midwest states: did they know what TMS, or transcranial magnetic stimulation, was, and did a drug-free depression option matter to them? A clear majority, 64 percent, valued a drug-free option. Only 25 percent had heard of TMS. Just over half of everyone surveyed wanted drug-free care and did not know TMS existed.
Those whole-sample numbers are final and validated. Respondents with commercial insurance, 173 of them, cared more still: 71 percent wanted a route without medication.
Two more findings explain why the conversation has to begin with you. Most people let their doctor steer: in the survey, 74 percent said a physician's recommendation would be their reason to try something new. But if neither patient nor doctor raises a treatment, it never enters the discussion. You can change that with one sentence.
Before the visit
Write down:
- Every antidepressant so far, with dose, length of trial, and what ended it
- Any therapy you have done, the type if you know it, and for how long
- Your current symptoms: sleep, appetite, energy, concentration, work
- Your insurance card, and if you can find it, your plan's medical policy on TMS
Commercial plans that cover TMS usually require proof of prior medication trials and sometimes of psychotherapy. The list you bring is the backbone of any authorization request.
The script
Open with where you are.
"Today I would like to focus on my depression. I have been on [number] antidepressants over [time]. They have not given me enough relief, and the side effects have been hard. I would like to talk about options that are not another medication."
Name the option you want to explore.
"I have read about TMS, transcranial magnetic stimulation. Do you think I could be a candidate? If not, what would make it a bad fit for me?"
Ask about the full menu.
"Besides TMS, what else is there that does not rely on a new drug? Is there a type of therapy you would recommend alongside it?"
Ask about referral.
"If TMS makes sense, can you refer me to a psychiatrist or TMS practice in my network? I would prefer somewhere close to work or home, since I understand it involves frequent sessions."
Ask about insurance.
"My plan's policy seems to require documented medication trials. Can your office include my history in the referral so the prior authorization goes smoothly?"
What to expect in reply
"Let us try one more medication first." That may be reasonable, and it may also be what your plan requires before approving TMS. Ask: "How long would we try it before considering TMS? Would that trial count toward my plan's requirements?"
"I am not sure I know much about TMS." Ask for a psychiatry referral. Psychiatrists evaluate for TMS routinely.
"You are not a good candidate." Ask why. Metal implanted in or close to the head, past seizures, and some other conditions can rule TMS out. A clear reason and an alternative are what you want to leave with.
"What about esketamine?" Your doctor may raise Spravato, the esketamine spray that holds FDA approval for treatment-resistant depression, given at certified clinics with observation afterward. It is a medication, so if avoiding drugs is your goal, say so. It may still be worth hearing about, since many people had not: 73 percent of survey respondents did not know the name. Brain Recovery Centers keeps a short explainer on Spravato if you want to read up first.
If you get pushback about cost
Some offices will warn that TMS is expensive or hard to get approved. Both can be true, and neither is a reason not to ask. Request that the office check your plan's criteria before ruling it out, and ask the TMS practice for a benefits check, which many run at no charge. An insurer's no can also be appealed, often with nothing more than better records.
Facts to have straight
- TMS devices hold FDA clearance for adults whose major depression medication has not sufficiently improved. "Cleared" is the device term; drugs are "approved."
- You are awake and alert during sessions, with no anesthesia, and can usually drive afterward.
- Expect a session most weekdays across several weeks.
- Headache and scalp discomfort are common. Seizure is a rare but serious risk that clinicians screen for.
- Many people keep taking their antidepressant during TMS. Do not stop any medication on your own.
After the appointment
Call your insurer and confirm three things: that the TMS practice you were referred to is in network, whether prior authorization has been submitted, and your expected cost-sharing for the full course. In the St. Louis area, double-check network status if the practice is across the river from where your plan is based.
Coverage mattered more than anything else to survey respondents, 85 percent of whom put it in their top two provider priorities. Just over half preferred wrestling with coverage rules to paying cash for a faster start.
This script is not medical advice, and there is no certainty that a treatment will work.
If depression has carried you to thoughts of ending your life, the referral can wait. You should not. Text or call 988. A Suicide and Crisis Lifeline counselor is on the line right now, free and in confidence.
Methodology
The survey cited here was requested and funded by the publisher, and Pollfish collected responses on its consumer panel through June 23, 2026, finishing with n=443 adults 18 to 64 in Kansas, Iowa, Illinois, Oklahoma, Missouri, Ohio, Indiana, Wisconsin, Nebraska, and Minnesota. The commercial insurance group is the only subgroup cited; every figure is final after validation.