A patient has tried two antidepressants, maybe three. She is sitting on the exam table, and she asks you a question you have heard before in some form: "Is there anything else?" You know there is. What you may not have ready is the next sentence, the one that gets her from your office to a provider she will actually keep seeing.
Our survey of 443 Midwest adults suggests that sentence should start with coverage. Respondents picked the two qualities they would weigh most when choosing a clinic for a newer depression treatment; "covered by insurance" made that short list for 85 percent. The runner-up, a location close to home, drew 43 percent, roughly half that share.
Why coverage belongs in your first sentence, not your last
Most referral conversations explain the option first and mention cost last, if at all. The people we surveyed would flip that order. If coverage is left hanging, everything else you say competes with a worry the patient has not voiced.
A second question in the survey makes the same point from a different angle. For 65 percent, coverage would weigh heavily on whether they tried the treatment in the first place, a figure that joins 22 percent who called it decisive with 43 percent who called it big. Only 14 percent said coverage would not matter.
The opening
"There are options beyond another pill, and I think one of them is worth looking at for you. Before I explain it, I want to find you a place that works with your insurance and is not a long drive, because those two things decide whether people actually go."
Naming the treatment without losing the room
If the option you have in mind is esketamine, the nasal spray sold as Spravato, expect a blank look. The name was unrecognized by 73 percent of our respondents, nearly three quarters of them, and a mere 6 percent knew what the drug was.
Lead with the category and the approval status instead:
"It is an FDA-approved spray, used in the nose, for depression that ordinary medications have not helped. Each dose happens inside a certified clinic, staff keep an eye on you for a couple of hours after, and someone else drives you home."
The FDA detail is not decoration. Our poll found 59 percent would treat FDA approval as deciding or at least big. It also separates the approved product from at-home ketamine services, a different and less regulated thing.
The coverage conversation, in four lines
You can prepare the patient without verifying benefits yourself:
- "The clinic will likely need a prior authorization. That is normal, and it mostly comes down to showing which medications you have tried before."
- "I will put your medication history in the referral so they are not starting from zero."
- "When you call your plan, ask whether this treatment is covered, whether it is billed on the medical or the pharmacy side, and which certified clinics count as in network."
- "If the answer is no, call me before you give up. Denials can be appealed, and sometimes the fix is paperwork."
Just over half of respondents told us they would rather work through an insured route with extra steps than pay their own way down a simpler one. Paying to skip ahead appealed to 23 percent; 26 percent could not choose. Most patients will tolerate the hoops if someone tells them the hoops exist. The failure mode is surprise.
Know which payer is in front of you
The payer mix in our sample is worth knowing before you build a referral list. Commercial plans led the list at 39 percent, and Medicaid trailed by just two points at 37 percent, so neither payer can be treated as the minor one. Medicare covered 23 percent of the sample, 9 percent said they had no insurance, and 5 percent carried TRICARE. People could select more than one.
A list built only on commercial plans sends much of your panel to a dead end. Ask the clinics you refer to, directly, which Medicaid plans they accept in your state, whether they see Medicare patients, and whether they are TRICARE authorized. For patients who want the money side explained before they call anyone, this overview of treatment cost and insurance is a reasonable place to start.
Distance is the second filter
After coverage, proximity mattered most, and for esketamine it is not a small detail. Early treatment typically involves repeated visits in a short span, each with a monitoring window and a ride home. A clinic ninety minutes away is a very different commitment from one across town.
Say it out loud: "Treatment usually means coming in more than once a week at first, and you cannot drive yourself home. Who could take you?" If the answer is nobody, a closer clinic or better scheduling may matter more than any other feature.
Close with a handoff, not a hope
When we asked whose word would push them hardest toward something like this, 74 percent pointed to their own doctor, and ads drew just 2 percent. A sentence from you outweighs anything she will later see on a screen.
So end with something concrete:
"I am sending a referral today with your history attached. Here is the clinic's number and the name of the person who handles insurance there. If you have not heard from them in a week, call us and we will chase it."
What this script is not
Everything here describes how people say they pick care; it is not clinical guidance. Whether this spray or anything else fits a given patient stays your call, informed by her history, contraindications, and preferences. We have not described outcomes because the survey measured attitudes, not results.
If a patient discloses thoughts of suicide at any point in this conversation, that takes priority over every step above. Follow your practice's safety protocol before she leaves the room, and make sure she knows the Suicide and Crisis Lifeline never closes, day or night. She can call or text 988, and if she is a veteran she can press 1.
Methodology
We ran this survey through Pollfish, whose consumer panel supplied 443 adults between 18 and 64. They live in Kansas, Nebraska, Oklahoma, Iowa, Minnesota, Wisconsin, Illinois, Missouri, Indiana, and Ohio, and fielding ended June 23, 2026. Every figure is top-line, taken from the validated final export Pollfish delivered. Questions that allowed several answers add up past the whole sample. This site's publisher paid for the study and commissioned it.