Every referral carries a guess about the patient. When you pick which name to write on the slip, you are betting on what will make that person follow through. Most of those bets are reasonable. A few, measured against what patients actually told us, turn out to be off.

Our poll put a simple question to 443 adults spread over ten states in the Midwest: what would you weigh in picking a provider for a newer depression treatment, ketamine or esketamine among them? The answers are final, validated figures, and they capture attitudes rather than clinical outcomes. They still test the assumptions behind a referral list. Here are six worth testing.

Assumption one: patients pick the provider with the best reputation

Reputation matters, but it was not on the short list people built for themselves. We asked respondents to choose the two attributes that mattered most. Insurance coverage was one of those two for 85 percent. Being nearby came second with 43 percent, while FDA approval (27 percent) edged out speed (24 percent).

Put plainly, the first question in most patients' heads is not "Who is best?" but "Who will my plan pay?" A highly regarded clinic that is out of network may never get the call. If you refer to a practice because of its reputation, check its payer list before you hand the name over.

Assumption two: people will travel for something that might help

Some will, but distance weighs heavily. Nearly half of the people we polled ranked a clinic "close to home" in their top pair, second only to coverage.

That preference makes practical sense for esketamine in particular. The approved nasal spray is only given at certified sites, each dose comes with a stretch of observation, and patients should not get behind the wheel until the following day. The early weeks bring frequent visits. A long drive, multiplied by several visits a week and a required ride home, can sink a plan that looked fine on paper. When you choose between two in-network clinics, the nearer one is often the better referral.

Assumption three: privacy is what holds people back

Stigma around mental health is real, and discretion matters to some patients a great deal. As a deciding attribute, though, it ranked low. Eleven percent put "private or discreet" among their top two, a small slice next to coverage and distance.

Privacy still matters. It just rarely outweighs a practical barrier.

Assumption four: a veteran-focused clinic is the safest bet for veterans

Specialization in veterans and first responders was the least chosen attribute on the list, at 10 percent. That figure describes the whole sample. Veterans and first responders themselves were too small a group to report on their own, so we cannot say what they prefer, and we will not guess. For context, 2 percent of the people we reached were veterans or active military, 4 percent worked as first responders, and 29 percent had a parent or family tie to someone in one of those roles.

What the top-line result does suggest is that specialty branding is not a substitute for the basics. If a veteran-focused clinic is a strong fit, confirm it takes the patient's actual coverage, whether that is TRICARE, Medicaid, Medicare, or a commercial plan. Only 5 percent of respondents carried TRICARE, which makes it easy to forget, so know which clinics on your list are authorized for it.

Assumption five: patients who hit insurance hurdles will just pay cash

Some clinicians steer toward self-pay options because the insurance route looks exhausting. Patients mostly disagree. Given a choice between insured care with added steps and a self-pay route that starts sooner, just over half took the steps. Twenty-three percent would pay, and 26 percent could not decide.

The takeaway for a referrer is modest but concrete. Do not skip the insured path on your patient's behalf. Tell them prior authorization may be required, include the medication history the clinic will need, and let them decide whether the wait is worth it. Patients who want the numbers first can read an overview of treatment cost and insurance coverage.

Assumption six: your recommendation is one voice among many

This is the assumption with the biggest gap between belief and data. Patients see ads, hear podcasts, and read online. You might expect your voice to be diluted. It is not.

We asked respondents which single voice would most likely get them to try it. Their own doctor won with 74 percent. Family and friends got 18 percent. Four percent would listen hardest to a vet or responder whose posts they read, ads scraped together 2 percent, and podcast hosts 1 percent.

That raises the stakes. When your word counts for that much, a referral to a clinic the patient cannot afford or reach fails in the most visible way possible.

A checklist that follows from the six

  • For each clinic on your list, confirm which Medicaid plans, Medicare, commercial carriers, and TRICARE it accepts. Our sample split almost evenly: 39 percent reported a commercial plan, 37 percent Medicaid.
  • Note the distance and hours for each location, and whether evening or weekend sessions exist for patients who work.
  • Ask whether the clinic handles prior authorization in house and who the patient should call about it.
  • Know whether each clinic offers the FDA-approved product in a certified setting or ketamine used off label, whether through an IV or at home. These are different treatments with different oversight, and patients deserve to know which one they are being sent to.
  • Write the reason for the referral in words the patient can repeat. People will act on your recommendation, so make it one they can carry.

What the data cannot tell you

The survey measured what people say they would weigh. It did not measure whether any treatment worked for them, and it cannot say who is a good candidate. Only a clinician with the full history can make that call.

If you are working with a patient in acute distress, the referral can wait. Before anything else, give them the Suicide and Crisis Lifeline: 988, by call or text, with veterans able to press 1.

Methodology

Our publisher both commissioned and funded this study. The Pollfish consumer panel produced 443 completed answers, all from people aged 18 to 64 living in Iowa, Ohio, Missouri, Kansas, Illinois, Minnesota, Indiana, Nebraska, Wisconsin, and Oklahoma; the survey closed June 23, 2026. We hold top-line percentages and nothing finer. Items that allowed more than one answer can total above the sample, and every figure reflects Pollfish's completed validation.