Getting Spravato Covered Out-of-Network

Getting Spravato Covered When Your Provider Is Out-of-Network

What if the best Spravato provider near you is out-of-network? You may still be able to get coverage.

Option 1: Gap Exception

If there's no in-network Spravato provider nearby, you can request a gap exception:

• Insurance treats out-of-network provider as in-network
• You pay in-network rates
• Requires demonstration of network inadequacy

Option 2: Single Case Agreement

A temporary agreement for specific treatment:

• Negotiated rate with your insurer
• Usually for a set number of sessions
• Renewable if treatment continues

How to Request Gap Exception

• Document lack of in-network REMS providers
• Show distance/travel burden
• Submit formal request to insurer
• Include supporting clinical documentation

At Next Step Psychiatry

Good news: Next Step Psychiatry is in-network with most major insurers, including:

• Blue Cross Blue Shield
• Aetna
• Cigna
• UnitedHealthcare
• And more

Verify Your Network Status

Call (678) 437-1659 or contact us to check if we're in your network.