I have private insurance, and I can’t find a mental health provider in my network. What can I do?

You are not alone. Far too many individuals across the country have difficulties with getting treatment, even if they have health insurance. That’s why NAMI is here to help guide you to find the care that you need and deserve.

Most comprehensive health insurance plans (also called a health plan, insurer, insurance company, insurance plan, etc) in the U.S. are required to cover mental health services. If you have health insurance, part of the contract you have with your health insurance plan is that you pay a monthly amount of money (called a premium) and you get access to in-network health care providers at a lower-than-normal cost if you have a challenge or just need a check-up.

If you can’t find an in-network mental health provider (psychiatrist, psychologist, therapist, social worker, etc.), the first step is to go to your health insurance plan.

Steps to finding an in-network mental health provider

Reach out to your health insurance company's customer service*. Call the number on the back of your insurance card and ask for a list of referrals for in-network mental health providers in your area who are accepting new patients. You can also let them know what kind of therapy you want, what setting (in-person or online), what gender/race/ethnicity/language or background the therapist has, and days and times that work for you. (*Sometimes insurance companies have an agreement with another insurer to cover mental health and substance use disorders for their health plan members, so don’t worry if you are referred to a company different from your insurer to help you find an in-network therapist.) Within a week or two, they should send you a list of in-network mental health providers who are taking new patients.
Look up in-network mental health providers yourself. You can also search your insurer’s online provider directory yourself and filter by what you want in a provider.  
Reach out to your EAP. If you have a job and your company has an Employee Assistance Program (EAP), (ask your human resources department about it if you are not sure) reach out to them. They may be able to help you figure out your insurance benefits, find a therapist, or take advantage of other benefits that your company offers.

Still can’t find an in-network provider you want? Check out this article for other resources that can help you find a therapist.

How to reach out to mental health providers

Reach out directly to mental health providers by their preferred method of contact. Some may have a form on their webpage; others have email addresses, or phone numbers. This is the best way to see if they are accepting new patients and to see if they provide the services you want at days and times that work for you. Treatment locators and other search engines are not always up to date with the most accurate information about mental health providers, so reaching out directly is your best option.  
Take notes. As you are contacting potential providers, keep notes about which providers you contacted on what dates, including if you follow-up with another call or email.
Reach out to many mental health providers at a time.  It sometimes takes time to get a response from a mental health provider; contacting a larger number will increase your chances of hearing back from someone who can help.  
Follow up. In one week, reach out again to all the mental health providers you contacted if you have not heard back. Add the dates of follow-up and which providers you reached out to again to your notes.

What if no mental health provider responds?

Get your notes ready. Have the list of providers and dates that you reached out to as proof that you tried to find a provider on your own. 
Reach out to your insurer. If you have made reasonable efforts to contact multiple providers and have not managed to find one who can take you as a new patient, call your insurance plan customer service.  
Tell them no in-network provider is available to help you. Inform the customer service representative at your insurer that you could not find a provider despite multiple attempts. Provide the notes that you took with a list of the providers you contacted including the dates you contacted them, if needed. 
Ask for help. The customer service representative may be able to schedule an appointment for you. (To add to your notes, consider asking for the customer service representative’s email address to also send the request in writing; ask that the representative reply to your email.)  
Ask to file a grievance. If the customer service representative does not get you an in-network provider in a reasonable amount of time, ask to file an administrative grievance which is basically a formal complaint that you make against your insurance plan to say they are not fulfilling their contract with you. 
Follow up regularly with the insurer's customer service until the grievance is resolved and you have an in-network provider who can help you. Or if they can’t find you an in-network provider, they may help you find an out-of-network provider that they will pay for and have you pay your copay or coinsurance (the amount of money you pay) at an in-network cost.
Ask to speak to a manager or supervisor if you are not making progrss.

If your insurance company is not helping you

Contact your insurance company’s regulator while you are waiting for your insurer to address your concern.

Find out which government agency regulates your insurer. If you bought a health plan from your state’s Health Insurance Marketplace, or have a fully insured plan through your private employer, you can get in touch with your state’s insurance department. If you have a self-funded plan from your private employer or a health and welfare benefit plan from your union, you can try the U.S. Department of Labor’s Employee Benefits Security Administration.
Write up your notes and submit. Write up a summary of the efforts you made to find a provider, and the names and dates of people you spoke to or emailed at your insurer and what was discussed. Submit that information to the regulator. 
Reach out to your human resource department. Your company buys this insurance to provide you with care. If the insurer is not helping you, your company should know. They may also talk to your insurer directly on your behalf. You do not need to tell your human resource department the specifics of what health care service you need or illness you need help for if you don’t feel comfortable sharing.

Get involved locally to hear about what services are available in your community

Joining your local NAMI affiliate or NAMI State Organization and going to programs, events, or support groups may introduce you to people who have looked for and found mental health treatment and services in your local area, and they may be able to share information and resources helpful for your particular situation.

Hours of operation: Monday-Friday, 10 a.m. – 10 p.m. EST

Call: 800-950-NAMI (6264)

Text: 62640

Email: helpline@nami.org

Website: www.nami.org/help