Picture a simple grid on your office wall. Across the top: close to the patient, or far. Down the side: covered by their plan, or not. Every esketamine site you might refer to falls into one of those four boxes for any given patient. Most failed referrals start with a site in the wrong box.
This guide is for primary care physicians, nurse practitioners, and referral coordinators anywhere in the country. It shows how to build and use that grid, anchored in our summer poll of 443 adults across ten Midwest states, whose whole-sample figures are final.
Why these two axes
Respondents each chose two things they would prioritize in a ketamine or esketamine provider. Insurance made 85 percent of the lists and closeness 43 percent. Nothing else came near. FDA approval edged quick results, 27 percent to 24, while privacy mattered to 11 percent, and a specialty in treating veterans or first responders to 10.
Coverage and distance are the axes patients use. It makes sense for referrers to use them too.
Step one: plot the sites
Start with the certified sites in your region. Spravato, the esketamine spray, is approved for treatment-resistant depression, and only certified healthcare settings may give it. The manufacturer's public treatment center locator lists them. Add sites colleagues recommend, and community behavioral health centers that evaluate and refer.
For each site, note:
- Address and approximate drive time from the main towns or neighborhoods your patients live in.
- Whether public transit reaches it.
- Which plans it accepts, by name, including specific Medicaid managed care plans, Medicare Advantage plans, commercial carriers and their behavioral health vendors, and TRICARE.
- Its self-pay price, in writing.
Step two: define "close" for your patients
"Close" depends on your practice. In a dense city, it might mean twenty minutes. In a rural county, an hour may be the best available.
For esketamine, define it with the treatment schedule in mind. Each dose is followed by two hours or more of observation, and the patient needs a driver. Induction usually means two sessions a week for the first month. A reasonable working definition of close is a round trip a patient's companion could make twice a week without losing a job over it.
Step three: sort each patient into the grid
At the referral visit, two questions place the patient: "What plan are you on?" and "Where do you live, and who could drive you?" Then look at the grid for that patient.
Box one: covered and close
The ideal. Refer here first. Send the medication history that prior authorization reviewers commonly request, and give the patient the site's name and number in writing.
Box two: covered but far
Common, especially for patients whose plans have narrow networks or who live in rural areas. Options:
- Check whether the patient's plan covers non-emergency medical transportation. Many Medicaid plans do.
- Help the patient plan the induction schedule and identify a driver before starting.
- Look for a site on a route the patient or their family already travels, such as near a workplace.
- Consider whether psychiatric evaluation and follow-up can happen by telehealth, reducing trips to only the dosing visits.
This box is where patients most need encouragement. Most are willing to put in effort for coverage. Among our respondents, 51 percent would accept insurance hurdles over simpler cash pay; 23 percent leaned toward paying, and 26 percent had not decided. For those patients, Brain Recovery Centers keeps a plain reference on esketamine costs and coverage.
Box three: close but not covered
Tempting, and sometimes the right call, but only with eyes open. The patient bears the full cost across a series of visits. Before referring:
- Confirm the site offers esketamine rather than off-label IV or at-home ketamine, if FDA approval matters to the patient. On a separate item, 59 percent of respondents rated approval big or decisive.
- Get the self-pay price in writing, including the evaluation.
- Ask about manufacturer assistance programs.
- Check whether the site might become in network through a single-case agreement with the plan, which some plans allow.
Box four: neither covered nor close
Usually a sign to step back. Options include a psychiatry referral to reconsider the treatment plan, a community behavioral health center for evaluation and support, or checking whether the patient qualifies for different coverage. Esketamine is one option for treatment-resistant depression, not the only one.
Keep the payer mix in view
When you fill in the plans each site accepts, do not stop at commercial carriers. Our respondents were split about evenly, 39 percent on commercial plans against 37 percent on Medicaid, with Medicare at 23, TRICARE at 5, and 9 percent with no coverage. A grid built only for commercial plans leaves many patients in box two or four by default.
Keep the grid current
Networks change, so re-verify each site every few months and ask patients to report referrals that failed.
Give patients a copy of their box
Patients rarely know the treatment by name. The brand name was unfamiliar to 73 percent of people in our poll. A short handout with the treatment name, the chosen site, its phone number, the expected schedule, transportation options, and the 988 crisis line turns the grid into something the patient can act on.
Your recommendation is likely what gets them to use it. For 74 percent of respondents, a physician's say-so is what would tip them toward trying it, and 56 percent planned to raise the question in primary care first.
Limits
This guide uses whole-sample figures only, with no payer or location breakdowns. It describes how people choose care and is not clinical evidence. Whether esketamine suits a given patient is your clinical judgment.
Whichever box a patient lands in, their handout should carry 988. That Suicide and Crisis Lifeline number answers calls and texts day and night, every day of the year.
Methodology
Behind the grid is Pollfish survey 395586438, answered by panel members until June 23, 2026, with 443 completes; respondents, aged 18 to 64, lived in Minnesota, Kansas, Missouri, Ohio, Iowa, Illinois, Wisconsin, Indiana, Oklahoma and Nebraska. Provider factors were choose-two and coverage multi-select. Figures are overall totals, validated and final. The publisher asked for this research and financed it.