Waiting is the hardest part. You have finally decided to try something new, since the medications never lifted your depression, and now you are told the insurance approval could take a while. Meanwhile, a clinic says it could see you next week if you pay. Do you wait, or do you pay now?
This FAQ focuses on that timing question for Missourians. Its numbers come from 443 adults we polled in Missouri and nine neighboring states. The figures are final and describe preferences, not outcomes.
Do most people wait for insurance?
Most say they would. Offered a choice between a covered treatment with more hoops and a self-pay option with fewer, 51 percent of respondents chose coverage. Another 23 percent would pay out of pocket, and the last 26 percent could not decide.
Speed ranked well below coverage. Given two picks, 85 percent of respondents chose insurance and only 24 percent chose fast results.
What exactly am I waiting for?
With esketamine, the FDA-approved spray for depression that holds out against treatment, the covered route usually involves a referral, a psychiatric evaluation, and a prior authorization request from the treating clinic to your insurer. The prior authorization is often the slowest part. Ask the clinic when it was submitted and how long your plan usually takes.
What can I do while I wait?
Quite a lot. Waiting for approval does not have to mean waiting for care.
- Keep seeing your primary doctor or current prescriber. They may be able to adjust your medication in the meantime.
- Ask about therapy. Psychotherapy can start while paperwork runs.
- Ask whether TMS, a drug-free treatment, might fit; 64 percent of those we polled wanted a way forward without more drugs.
- Line up drivers for future sessions, since you cannot drive after an esketamine dose until the next day.
- Keep a log of every call about your authorization.
Is the clinic that can see me next week offering the same treatment?
Ask directly. Cash-pay clinics commonly offer IV ketamine infusions, an off-label depression use, rather than esketamine. Some online services prescribe ketamine for home use, which involves much less supervision. These are different treatments with different oversight. Among our respondents, 59 percent gave FDA approval big or deciding weight, so it is worth knowing which one you would be paying for. A Brain Recovery Centers page covers what esketamine costs and how coverage works if you want to compare.
If I pay now, can insurance reimburse me later?
Do not count on it. Insurers generally require prior authorization before covered treatment starts, and self-pay clinics may be out of network. If you are hoping for any reimbursement, ask your insurer before you pay anything, and get the answer in writing if you can.
Will what I pay count toward my deductible?
It depends on your plan and whether the provider is in network. Out-of-network or uncovered services often do not count. Ask your insurer.
Can I use an HSA or FSA to pay?
Health savings and flexible spending accounts can often be used for medical treatment prescribed by a clinician. Rules vary, so check with your account administrator before assuming a particular service qualifies.
Can I start paying now and switch to insurance later?
Possibly, but switching may mean starting a different treatment. If you begin with IV ketamine and later want covered esketamine, you will still need the evaluation and prior authorization. Keep copies of all records from any self-pay clinic, because your future prescriber and insurer may ask about them.
Can I pursue both at once?
Some people do: they start the covered process and, with their clinician's input, consider other care in the meantime. Talk to your doctor before combining treatments, since some combinations may not be safe or may complicate an approval.
I am on MO HealthNet. Does that change the timing?
MO HealthNet coverage is usually administered through a managed care plan, and each plan sets its own authorization process. Call the number on your plan's card and ask how long esketamine approvals typically take and which certified sites are in network. Medicaid members may also have non-emergency medical transportation, which can solve the driving requirement. Medicaid was the second most common coverage in our sample, reported by 37 percent of respondents, just behind commercial plans at 39 percent.
How long is too long to wait?
That is a clinical question, not a financial one. If your symptoms are getting worse while you wait, tell your doctor right away. They may change the plan, speed up a referral, or suggest other options.
If you have thoughts of suicide at any point, the answer is simple: do not wait at all. Call or text 988 immediately.
What if the wait is mostly about finding a site near me?
Across rural stretches of Missouri, a certified esketamine site can be a long drive off, and in the metros it may still be across town. You are not alone in caring about distance, since 43 percent of respondents named nearness to home as a leading priority. Ask your insurer for every in-network certified site within reach, not just the nearest one, since a slightly farther site may have a shorter wait.
Where should I start today?
Most people would start with a doctor they know, as 56 percent of respondents said they would. Bring your written antidepressant history and ask whether you might be a candidate for esketamine or other options. Then call your insurer. That is enough to know whether waiting is worth it.
A clear line
This FAQ offers no medical, insurance, or financial advice. Esketamine's approval is for depression that has resisted treatment, with dosing only under certified supervision; your clinician decides whether it or anything else is right.
Waiting on paperwork should never mean waiting alone. In a crisis, anyone in Missouri can text or call 988 and get the Suicide and Crisis Lifeline, free, day or night.
Methodology
Missourians and their neighbors answered Pollfish survey 395586438 as consumer-panel members, and it closed June 23, 2026: 443 completes from adults 18 to 64 in Missouri, Kansas, Nebraska, Oklahoma, Iowa, Illinois, Wisconsin, Indiana, Minnesota and Ohio. Several payer answers were allowed per person. All results are validated. The publisher requested and paid for the poll.