When You Can't Find an In-Network Psychiatrist in New York
Short answer
If your plan follows New York law, it must be able to offer an in-network outpatient mental health appointment within 10 business days of your request, or within 7 calendar days after a hospital or emergency room discharge. If it cannot, you can file an access complaint. If the plan still finds no one within 3 business days, it must approve an out-of-network referral at your in-network cost. Self-funded employer plans follow different rules.
In crisis or thinking about suicide? Call or text 988 now (in New York City it reaches NYC 988). If you are in immediate danger, call 911.
This guide is not enough if
- You are in crisis or thinking about harming yourself. Call or text 988, or call 911 if you are in immediate danger.
- You have Medicare. Different rules apply, and Medicare explains them.
- Your employer plan is self-funded. New York's access rules do not apply, so use your plan's own documents.
- You need a decision about a medicine you take now. Talk with your current prescriber before changing anything.
- You want legal advice about a dispute. This page is general information only.
You have called the list and no one can see you
You have the insurance directory open, you have called name after name, and the answers are the same: not taking new patients, a wait of months, or no call back. That is tiring, and it is common enough that New York wrote rules for it.
This guide covers what you can ask your plan to do when its network cannot see you in time. If you have not called your insurer yet, start with questions to ask your insurer. For what a practice's intake call usually covers, see what happens when you call.
First, check that New York's rules cover your plan
New York's Department of Financial Services (DFS) says these rules apply to individual and group policies subject to New York law, including plans bought through NY State of Health. They took effect for Medicaid Managed Care, the Essential Plan and Child Health Plus on July 1, 2025. Other policies come under them when they are issued or renewed on or after July 1, 2025, and DFS says individual policies follow them from January 1, 2026.
The rules do not apply to self-funded ERISA employer plans. A New York ID card that says "fully insured coverage" means your coverage follows New York law. If your card does not say so, ask your employer's benefits office whether the plan is fully insured or self-funded. If you have Medicare, different rules apply.
The wait-time standards
Under New York's network adequacy regulation (11 NYCRR Part 38), a plan's network must be able to offer you an appointment with a provider who can treat your condition within these times:
- 10 business days for a first outpatient appointment with a licensed professional, a clinic or an outpatient facility.
- 7 calendar days for an appointment after you leave a hospital or an emergency room.
- Telehealth visits can count toward these times, unless you specifically ask for an in-person appointment.
- The wait is measured from your first request to the earliest date you are offered.
- Your plan must have staff who help you find in-network providers, and DFS says it must send a list of available ones within 3 business days of your request.
How to use an access complaint
If no in-network provider can see you within those times, you or someone you choose can file an access complaint with your plan, by phone or in writing. You might say: "I have not been able to get a first appointment with an in-network psychiatrist within 10 business days, and I want to file an access complaint." These steps follow the regulation and the DFS fact sheet:
- Keep a log. Write down each clinician you called, the date, and the earliest appointment offered. It shows the gap clearly.
- Call the plan and use the words "access complaint." Ask for a reference number and the date it was received.
- Wait up to 3 business days. The plan has that long to give you the name and contact details of an in-network provider who can treat your condition, meet the wait times and, if you asked for in-person care, is a reasonable distance away. DFS says the wait-time clock then restarts from when the plan contacts that provider.
- If the plan finds no one, it must tell you, by phone and in writing, that you may get a referral to an out-of-network provider at your in-network cost. It must also give you contact details for New York's Behavioral Health Ombudsman program.
- Find an out-of-network clinician. DFS says plans are not required to locate one for you. The plan must approve the referral if that clinician can treat your condition, can meet the wait times, is a reasonable distance away if you want in-person care, and does not charge excessive or unreasonable rates. This applies even if your plan has no out-of-network benefits.
- Get the approval in writing before the first visit. With an approved referral, your copay, coinsurance and deductible must be no higher than in-network, and your in-network out-of-pocket limit applies.
| Your situation | What you can ask for | Where the rule comes from |
|---|---|---|
| No in-network clinician can offer a first visit within 10 business days | File an access complaint; if none is found in 3 business days, an out-of-network referral at in-network cost | 11 NYCRR 38.4 and 38.5 |
| You were just discharged and need follow-up within 7 calendar days | The same access complaint, citing the 7-day standard | 11 NYCRR 38.4(a)(3) |
| The network has no one with the training your condition needs | A referral to an appropriate out-of-network provider at in-network cost, approved before care | Insurance Law 4804; Public Health Law 4403 |
| Medicaid Managed Care, Essential Plan or Child Health Plus | The same wait-time protections; complaints go to the Department of Health | DOH rules effective July 1, 2025 |
| Self-funded employer plan | The plan's own exception process, in writing; federal help from the Department of Labor | ERISA; state insurance law does not apply |
A separate rule when no one has the right expertise
An older New York rule covers a different gap: the plan has providers, but none with the training and experience your condition needs. For insurers' managed care products (Insurance Law section 4804) and HMOs (Public Health Law section 4403), the plan must then refer you to an appropriate provider at no extra cost beyond in-network, under a treatment plan it approves.
This usually needs approval before care starts. DFS says that if the plan denies the referral, it must explain why and name in-network providers. You can appeal, and the appeal must include a written statement from your attending physician saying the in-network providers lack the needed training and experience and that an appropriate out-of-network provider is available. Notes on which in-network clinicians you contacted, and what they said, can support that request. The steps are in appealing a mental health claim denial.
If the plan says no, or these rules do not fit
If your plan does not follow these rules, DFS says to file an appeal with the plan and a complaint with the state. For most plans that means DFS; for Medicaid Managed Care, the Essential Plan or Child Health Plus, it means the Department of Health. New York's Behavioral Health Ombudsman program (CHAMP) can help with questions, complaints and appeals.
If your plan is self-funded, the U.S. Department of Labor says these plans are not subject to state health insurance laws. Ask the plan administrator what process it has when its network cannot see you, and read your plan's summary plan description. The federal parity rules may still apply.
Sometimes the faster path is to pay outside the network, either with out-of-network benefits or as self-pay. Comparing in-network, out-of-network and self-pay walks through that choice, and how out-of-network benefits work in New York explains the math. Mind Body Seven is out-of-network with all insurance plans and does not accept Medicare or Medicaid. Its fees and insurance page describes how claims and superbills work there and names its sister practice, Integrative Mind, as an in-network option for adult psychiatry and medication management. You can also read about out-of-network psychiatry.
Frequently asked questions
Does a telehealth appointment count toward New York's 10-day rule?
Yes, in most cases. New York's regulation lets a plan meet the wait times through telehealth unless you specifically ask for an in-person appointment. If in-person care matters to you, say so clearly when you file the access complaint. The plan then has to find a provider within a reasonable distance, and DFS notes that distance may be longer in rural areas.
Can I choose the out-of-network psychiatrist myself?
Often you will have to. DFS has said plans are not required to locate an out-of-network provider for you. Once the plan tells you it cannot find anyone in-network, you can bring it a clinician who can treat your condition, meet the wait times and charges rates that are not excessive or unreasonable. Ask the plan to confirm the referral in writing before your first visit.
Does this work if my plan has no out-of-network benefits, like an HMO or EPO?
For plans under New York's regulation, yes. The rule says the plan must approve a qualifying referral regardless of whether your coverage includes out-of-network benefits. That is what makes the access complaint useful for HMO and EPO members. It still applies only when the plan cannot find an in-network provider in time, and only to coverage subject to New York law.
How long does an approved out-of-network referral last?
Under the regulation, it lasts until the services are no longer medically necessary, or until the plan finds an in-network provider who meets the standards and your care can move there. The plan should not move you if, in consultation with your treating provider as appropriate, it decides the switch would be harmful. If you disagree with a transition decision, you can ask for an expedited review or appeal.
How do I know if my employer plan is self-funded?
Look at your member ID card first. DFS says a card showing the phrase "fully insured coverage" means your coverage follows New York law. If you do not see it, ask your employer's HR or benefits office, "Is our plan fully insured or self-funded?" A well-known insurer can run the claims for a self-funded plan, so the insurer's name on the card does not answer the question by itself.
Next: take the next step
When you are ready, read more about how Mind Body Seven can help, in Brooklyn or by telehealth across New York State, or request a consultation and an Intake Coordinator will follow up.
Sources
- NYS DFS: Know Your Rights, Getting Treatment for Mental Health and Substance Use Disorders (February 2026)
- NYS DFS: Insurance Regulation 230, 11 NYCRR Part 38 (adopted text)
- NYS DFS: Assessment of public comments on Insurance Regulation 230
- NYS DFS: Mental Health and Substance Use Disorder Information
- NY Insurance Law section 4804, Access to specialty care
- NY Public Health Law section 4403
- U.S. Department of Labor: Technical Release 2014-01 (self-insured plans and state law)
- Mind Body Seven: Fees and Insurance
Recent changes
- February 23, 2026: DFS updated its consumer fact sheet on getting mental health and substance use treatment, including the 10-business-day and 7-calendar-day standards and the access complaint steps. NYS DFS: Know Your Rights, Getting Treatment for Mental Health and Substance Use Disorders
- July 1, 2025: New York's network adequacy and access standards for behavioral health (Insurance Regulation 230, 11 NYCRR Part 38) took effect, applying to policies issued or renewed on or after this date. NYS DFS: Final adoption of Insurance Regulation 230 (11 NYCRR 38)
Reviewed by Dr. Beata Lewis, MD, Founder and Clinical Director, board-certified in adult psychiatry, child and adolescent psychiatry, and integrative medicine on November 8, 2026. Facts checked against the sources above on November 8, 2026. This guide is general education, not medical advice, a diagnosis or a treatment plan, and reading it does not make you a patient of Mind Body Seven. For advice about your situation, talk with a licensed clinician.