You have decided you want to use your insurance. It may take longer, but it is the route that makes sense for your budget, and you are willing to do the legwork. Good. You are in the majority. Now what, exactly, do you do first?
This guide breaks the insured route to esketamine, a nasal spray approved for depression that ordinary treatment has not moved, into stages for people living in O'Fallon and the rest of St. Charles County. It does not promise a timeline, because approvals and wait lists vary. It does tell you what each stage asks of you and how to keep it moving.
You are not alone in choosing this route
Our June 2026 poll gave 443 adults in ten Midwest states a plain tradeoff: coverage with extra steps, or paying cash for an easier process. Just over half took the insured route, 23 percent would pay cash, and 26 percent had no answer yet. Coverage also led every other provider priority, on 85 percent of two-item lists. These figures are final; Pollfish has completed its validation.
Stage one: gather what you already have
Before any appointment, spend an evening collecting:
- Your insurance card, front and back, and the plan's member services number.
- A list of every antidepressant you have taken: name, approximate dates, approximate dose, and why it stopped. Your pharmacy can print a medication history if your memory is fuzzy.
- Therapy you have tried, with rough start and end dates.
- Your primary doctor's name and number.
This stage costs nothing and it is the one that most often decides how smooth the rest will be. Insurers usually want proof of what has already been tried before they approve esketamine.
Stage two: call your insurer
Before your doctor visit, call member services and ask:
- "Is esketamine, brand name Spravato, covered under my plan?"
- "Does it require prior authorization?"
- "Does it fall under the medical side of my plan or the pharmacy side?"
- "Will a psychiatrist visit need a referral first?"
- "Which certified esketamine treatment sites near O'Fallon are in my network?"
Note the date, who answered, and any reference number. If they cannot answer every question, that is normal. You are gathering, not deciding.
If you have MO HealthNet, your coverage is usually administered by a managed care plan. Call the number on that plan's card, since networks and rules differ between plans. If you live in O'Fallon, Illinois, your Medicaid plan will be an Illinois plan, and it may limit which Missouri providers are in network.
Stage three: see your primary doctor
Most people start here: 56 percent of our respondents said a primary doctor would be their first stop. Book a visit specifically about depression, bring your medication list, and ask:
- "After everything I have taken, does this count as treatment-resistant depression?"
- "Would you send a referral to psychiatry or to a certified treatment center?"
- "Could my chart spell out every medication trial in full?"
That last request matters. The treating clinic will pull from your chart when it asks your insurer for approval.
Stage four: the psychiatric evaluation
A psychiatrist or other prescriber, often connected to a certified site, will evaluate whether esketamine is appropriate. They will review your history, blood pressure, and other health factors. Some people are not good candidates, and a clinician may recommend a different option, such as a medication change or TMS, a drug-free treatment.
Keeping it moving: If the wait is long, ask to be put on a cancellation list. Ask whether telehealth evaluation is available, which may be quicker. Keep seeing your primary doctor in the meantime.
Stage five: prior authorization
If esketamine is recommended, the clinic submits a request to your insurer with your diagnosis, medication history, and symptom scores. The insurer approves, denies, or asks for more information.
Keeping it moving: Ask the clinic when they submitted it and when to expect an answer. Call your insurer to confirm they received it. If it is denied, ask the clinic about an appeal or peer-to-peer review, and get any missing records from your primary doctor. For a map of the process, see the Brain Recovery Centers page on esketamine costs and how coverage decisions work that can help you follow the process.
Stage six: plan the logistics
While you wait for approval, sort out the practical side:
- Rides. Driving is out after every session until the next morning, and the early weeks are busy. Line up drivers now: a partner, family, friends, or a rotation.
- Distance. Some certified sites sit in St. Charles County; others are over the Missouri River in St. Louis County. A trip down I-70 or across Page Avenue at rush hour, twice a week, adds up. Being close to home mattered to 43 percent of our respondents.
- Transportation benefits. MO HealthNet plans often include rides to non-emergency medical appointments. Ask your plan how to schedule it and confirm the clinic will release you to that ride.
- Time off. Sessions include a monitoring period after each dose. Plan for a meaningful part of the day.
Stage seven: the first session and beyond
A staff member watches while you use the spray, and you remain afterward for observation. Over time, your clinician will track symptoms with questionnaires, partly to decide whether treatment is helping and partly because your insurer may require updates to keep approving it.
Keeping it moving: Keep your appointments and answer questionnaires honestly. If sessions stop helping or side effects are a problem, tell the team.
The single most useful habit
Keep a running log: every call, every date, every name. It turns a confusing process into one you can manage, and it makes any appeal far easier.
Important limits
None of this is medical or insurance advice, and coverage varies by plan. The FDA approved esketamine for depression that resists treatment, and only certified clinics may give it, under supervision. Whether it is right for you is your clinician's call.
If at any stage you find yourself thinking about suicide, drop the paperwork. The Suicide and Crisis Lifeline answers 988 by phone or text, free, around the clock.
Methodology
O'Fallon readers should know the source. We fielded Pollfish survey 395586438 with panel members until June 23, 2026, and ended with 443 completes, all adults 18 to 64, in Wisconsin, Iowa, Minnesota, Illinois, Kansas, Missouri, Indiana, Oklahoma, Nebraska and Ohio. The figures are final. The publisher commissioned and financed the poll.