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A National Resource The Depression Guide

From our survey

Building an esketamine referral list that matches coverage

Replace the sticky note with a coverage-matched map: find certified sites, call each with the same questions, and organize by payer.

Every referral leans on the list behind it. For esketamine, the list most practices keep is a name or two, maybe a phone number someone wrote on a sticky note after a lunch presentation. This guide is about replacing that with a short, coverage-matched map your staff can use in under a minute.

It is written for primary care physicians, nurse practitioners, and the staff who route referrals. It rests on one result from our summer poll: among 443 adults across ten Midwest states, commercial insurance and Medicaid landed two points apart, 39 against 37 percent, while Medicare held 23 percent, the uninsured 9, and TRICARE 5, with more than one answer allowed. These numbers are final and validated.

Why a coverage-matched list matters

Patients filter every option through coverage. Asked for the pair of provider traits that matter most, our respondents put insurance on 85 percent of lists and a short trip on 43 percent. A list that pairs each site with the plans it accepts, and roughly where it sits, answers both questions at once.

Patients also rely on you to point the way. In our poll, 74 percent said a doctor's recommendation would get them to try it. When a trusted recommendation leads to a site that cannot accept the patient's plan, the trust does not transfer. The patient simply stops.

Step one: find the certified sites in your area

Esketamine, sold as Spravato, is available only at healthcare settings certified under its REMS program. The manufacturer maintains a public treatment center locator that lists certified sites. Start there, then add sites you know from colleagues and local psychiatry groups. Aim for every site within a reasonable drive of your patient population, not only the closest.

Include community mental health centers even if they do not offer esketamine themselves. They often accept Medicaid, can perform evaluations, and can refer onward.

Step two: call each site with the same questions

Consistency is what makes the list useful. Have one staff member call every site and ask:

  • Which Medicaid managed care plans do you participate with, by name?
  • Which commercial carriers, and are you in network with their behavioral health vendors?
  • Do you see traditional Medicare patients? Which Medicare Advantage plans?
  • Do you accept TRICARE, and what referral paperwork do you need?
  • What is your self-pay price for the evaluation and for sessions?
  • Who handles prior authorization, you or the referring clinician?
  • What documentation do you want with a referral?
  • What is the current wait from referral to first session?
  • Can you coordinate with Medicaid transportation benefits?

Record the name of the person who answered and the date. Network participation changes, and a date tells you when to call again.

Step three: organize by payer, not by site

Most lists are organized by clinic. Flip it. Organize the sheet by coverage type, with the sites under each:

  • Medicaid: each managed care plan as its own row, with the sites that accept it.
  • Commercial: major carriers and behavioral health vendors, with participating sites.
  • Medicare: traditional, then each Advantage plan common in your area.
  • TRICARE: participating sites and referral requirements.
  • Self-pay: sites with written pricing.

Now the routing question becomes one step: what plan is the patient on? Find that row, pick the nearest site.

Step four: add distance and logistics

Each esketamine session includes a stay of two hours or more after the dose, and patients need a driver. For many patients the round trip, and finding a driver, is the real barrier. Next to each site, note:

  • Approximate drive time from your office.
  • Whether public transit reaches it.
  • Whether the site has experience coordinating rides for patients whose plans cover transportation.

Brain Recovery Centers keeps a patient-facing explainer on esketamine costs by coverage type; it pairs well with this list when a patient's only covered option is far away.

Step five: prepare a referral packet

Ask each site what it wants to receive. In general, a referral for esketamine moves faster when it includes:

  • A diagnosis and a brief history of the current episode.
  • A medication history: names, doses, durations, and why each was stopped.
  • Relevant medical history, including blood pressure, substance use history, and any conditions the site will want to screen for.
  • The patient's insurance information, front and back of the card.

That medication history is often central to prior authorization, and it lives in your chart. Sending it at the start saves the receiving site weeks.

Step six: give the patient something to hold

Public awareness of the treatment is thin. Nearly three in four people we polled, 73 percent, had not encountered the name Spravato. A patient who cannot remember the name cannot call a plan to ask about it. A simple handout with the name of the treatment, the site you have chosen, its phone number, and the 988 crisis line closes that gap.

Most patients will also appreciate knowing that paperwork is normal. Just over half of our respondents would pick insurance with extra steps over simpler self-pay. Tell them the hoops exist, and who will help them through.

Step seven: keep it current

Set a reminder to re-verify the list every few months. Ask patients who went through the process what worked and what did not. A single patient's report that a site stopped accepting a plan is worth acting on.

Blind spots in these numbers

This guide reports overall figures only. It does not describe how any group within the sample, including Medicaid members, answered other questions. These are market research findings, not clinical evidence, and a patient's suitability for esketamine is your judgment. The approval covers treatment-resistant depression specifically, and it is distinct from off-label ketamine offered by infusion or at home.

Please keep crisis resources visible in every referral. A patient waiting for a first appointment should know 988, where Suicide and Crisis Lifeline counselors take calls and texts around the clock.

Methodology

For the referral desk: study 395586438 ran among Pollfish consumer panelists and stopped June 23, 2026, at 443 respondents aged 18 through 64 in Indiana, Wisconsin, Kansas, Illinois, Minnesota, Ohio, Missouri, Oklahoma, Iowa and Nebraska. Coverage type took multiple answers. Shares here describe the whole sample and are final. Funding and the original request came from this site's publisher.