From our survey
Time, per-session math, oversight, rides, time off and later paperwork: the costs neither route shows on the first quote or phone call.
The obvious comparison between using insurance and paying yourself is simple: one takes paperwork, the other takes money. The real comparison is messier. Each route carries costs that do not show up on the first quote or the first phone call, and they tend to surface after you have already committed.
This piece compares those hidden costs for Missourians weighing a newer depression treatment. Its numbers come from 443 respondents, Missourians among them, in a ten-state Midwest poll we paid for, and Pollfish has since validated them as final.
We offered a direct tradeoff: covered by insurance with more hoops, or pay yourself with a simpler process. Just over half of respondents chose coverage. Nearly one in four chose to pay themselves. The remaining 26 percent were not sure.
Coverage showed up everywhere else too. When our respondents ranked what they wanted in a provider, 85 percent put insurance in their top pair, and 65 percent said that whether they started at all would hinge largely, or entirely, on coverage. So the question is not whether cost matters. It clearly does. The question is which costs you can see coming.
The routes often lead to different treatments, and that shapes everything below.
Covered route: The waiting is front-loaded. A primary care visit, a psychiatric evaluation, a prior authorization, and possibly an appeal can stretch the start date out. While you wait, you are still depressed.
Self-pay route: Often faster to start. But speed at the start does not promise speed to improvement, and if the treatment is not right for you, the time spent is still time.
Worth knowing: Fast results made the top two priorities for only 24 percent of respondents, well behind coverage. Most people, it seems, will trade some time for coverage.
Covered route: Coverage does not mean free. Depending on your plan, you may owe copays, coinsurance, or deductible amounts. Esketamine may fall under your medical or pharmacy benefit, and the monitoring visit after each dose is billed separately. Ask for an estimate per session.
Self-pay route: The price per session may be quoted clearly, but these treatments involve a series of sessions, often followed by maintenance sessions. The number that matters is the total over months, which clinics may not volunteer.
Covered route: Esketamine comes with built-in safeguards: a certified site, a clinician watching you dose, monitoring afterward, and blood pressure checks. Your insurer also reviews whether the treatment fits your situation. That review is annoying, but it is a second set of eyes.
Self-pay route: Oversight varies widely. A reputable IV clinic may monitor closely. An at-home prescription may involve almost none. Nobody outside the clinic reviews whether the treatment suits you. For the 59 percent of respondents who rated FDA approval big or decisive, this is a real cost.
Both routes, for clinic-based treatment: After esketamine, a friend or relative drives, since the patient may not drive that day, and IV ketamine clinics typically require a driver as well. Early treatment involves frequent sessions. That means a driver, and possibly lost hours at work for you and for them.
Missouri note: Distance varies enormously across the state. Around St. Louis or Kansas City, a certified site may be close. In rural counties, it could be a long round trip. MO HealthNet members may have non-emergency medical transportation benefits, one hidden saving on the covered side. Among respondents, 43 percent said a short trip to the provider was one of the two things they cared about most.
Covered route: Many plans reauthorize periodically, asking for evidence that the treatment is helping. That is another hoop, but it also means coverage can continue if the treatment works.
Self-pay route: If treatment helps, you may be paying for maintenance indefinitely. If you later want to switch to a covered option, you will need records of what you received.
Here is a cost that appears on both sides: documenting your history. A covered route needs it for prior authorization. A responsible self-pay clinic should want it for safety. Writing down every antidepressant you have tried, with dates, doses, and results, is work you will do on either route.
Start with the conversation most respondents would start with, since 56 percent would begin at a primary care office. Ask whether esketamine might fit you, then call your plan to price the covered route. If you still want to consider self-pay, get a full, written estimate of the total cost and a clear description of what the treatment actually is.
This is general information, not medical or financial advice. Suitability for any treatment is a clinician's decision. For a fuller picture of the covered side, read how Brain Recovery Centers explains esketamine costs and insurance coverage.
No hidden cost should stand between you and help in a crisis. With suicide on your mind, text or phone 988; the Suicide and Crisis Lifeline charges nothing and never shuts.
Pollfish survey 395586438 took responses from its consumer panel until June 23, 2026, finishing with 443 completes from residents aged 18 through 64 of Nebraska, Missouri, Indiana, Kansas, Ohio, Iowa, Oklahoma, Minnesota, Illinois and Wisconsin. Validation is finished, and the figures stand as final. The publisher asked for the survey and paid for it.