We gave people a simple choice. Option A: a depression treatment covered by your insurance, but with more hoops to jump through. Option B: pay for it yourself and skip the hassle. Just over half of them picked the hoops.
That result comes from a June 2026 questionnaire answered by 443 people in a ten-state Midwest sample, and it says a lot about how people in places like St. Charles weigh money against convenience when their mental health is on the line. Every figure is final and validated.
The split
Here is how the tradeoff question came out:
- Covered by insurance, more hoops: 51 percent
- Pay yourself, simpler process: 23 percent
- Not sure: 26 percent
The covered route beat self-pay by better than two to one. And more than a quarter of respondents could not choose, which suggests many people do not yet know what either path would actually involve.
Coverage outranked everything else
The tradeoff question was not an outlier. Several other questions pointed the same way.
When we asked people to choose the two most important things in picking a provider, insurance coverage led by a wide margin, selected by 85 percent. A location near home came second at 43 percent, FDA approval landed on 27 percent of lists and quick results on 24 percent, and privacy trailed at 11 percent.
Side by side, the priority is unmistakable: our respondents picked coverage more than three times as often as speed. People are telling us they would rather wait for covered care than rush into care they pay for on their own.
A separate question asked how much insurance would weigh on trying the treatment at all: deciding for 22 percent, big for 43 percent (together 65 percent), some for 21 percent, none for 14 percent.
Why the covered route appeals, even with the hoops
Nobody in our poll was asked why they chose as they did, so the reading here is ours. But some reasons are easy to imagine.
Newer depression treatments involve repeated visits, and the costs can add up quickly without coverage. For many households, a monthly budget does not stretch to an uncovered series of sessions, no matter how convenient.
Coverage may also read as a quality signal. A treatment an insurer will pay for has usually cleared some bar of evidence. That lines up with another finding: FDA approval weighed big or decisively for 59 percent of respondents.
And the payer mix matters. Our respondents reported commercial plans most often, at 39 percent, with Medicaid close behind at 37 percent; Medicare accounted for 23 percent and TRICARE for 5 percent. For people on public coverage, self-pay may simply not be realistic.
What "the hoops" usually are
With esketamine, the approved nasal spray for depression that has resisted treatment, the hoops tend to look like this:
- Chart notes from a doctor showing earlier antidepressants did not help enough.
- The treating clinic filing a prior authorization with your plan.
- Finding a certified treatment site that is in your plan's network.
- Waiting for approval before the first session.
None of these is unusual in health care, and all go faster with organized records. Brain Recovery Centers publishes a plain explanation of esketamine costs and how insurance coverage works that is worth reading before you call your plan.
What the self-pay route usually means
The 23 percent who preferred to pay themselves may have different options in mind. Some clinics offer IV ketamine infusions for depression, which is an off-label use and is often not covered. Web-based services that mail ketamine for home use are less supervised and usually cash-pay. These are not the same as esketamine, and the regulatory differences matter. A simpler process is not always the same thing as a better fit.
What the choice looks like from a St. Charles kitchen table
Numbers like these become concrete quickly. Picture a household in St. Peters or O'Fallon where one adult has tried three antidepressants and is still struggling. The covered route means gathering pharmacy records, a primary care visit, a psychiatry evaluation, and a few weeks of waiting on an insurer. The self-pay route might mean a call to a clinic that could see them sooner, and a bill with no ceiling on how many sessions it covers. Neither choice is foolish; what matters is seeing both clearly, with a clinician's view of which treatments fit.
For the quarter who are not sure
If you are in St. Charles and cannot decide which route makes sense for you, you are in good company. A few questions can help:
- Does my plan cover esketamine, and does it require prior authorization?
- Which certified sites close by, on this side of the Missouri River or the other, take my plan?
- What would my out-of-pocket cost be per session with coverage?
- If I considered a self-pay option, what exactly is being offered, and is it FDA-approved for my condition?
Your primary doctor is a natural place to start these conversations. Most people in our survey agreed, with 56 percent naming a primary doctor as where they would begin.
The takeaway
Half of the people we surveyed were willing to put up with extra steps to use their insurance. That is a practical, patient choice, and it means the path to covered care is worth understanding before you need it. If you are weighing the options, the best preparation is a written list of past medications and a phone call to your plan.
Read this as poll findings rather than medical or financial advice. The FDA has approved esketamine for hard-to-treat depression, and only certified clinics may dose it, under supervision; a clinician decides whether it suits you.
No bill or form should keep you from help if ending your life is on your mind. The Suicide and Crisis Lifeline costs nothing; reach it by call or text at 988, any hour.
Methodology
Pollfish carried survey 395586438 to members of its consumer panel through June 23, 2026. We have 443 completes from people 18 to 64 living in Kansas, Minnesota, Iowa, Missouri, Illinois, Nebraska, Wisconsin, Oklahoma, Ohio and Indiana. A few items let people pick several answers. Every number is a full-sample figure from validated data. This site's publisher paid for the poll and requested it.