Can't Find an In-Network Psychiatrist? How New York's 10-Business-Day Rule Works

You have insurance, the directory lists dozens of psychiatrists, and none of them has an opening or treats adult ADHD. New York adopted appointment wait-time standards for this situation. They took effect on July 1, 2025 for Medicaid Managed Care, the Essential Plan and Child Health Plus, and for other New York-regulated policies as each one renewed or was purchased on or after that date.

The rule is often summarized online as a right to see any out-of-network psychiatrist at in-network cost after 10 days. That is not what it says. The steps below follow the fact sheet published jointly by the Department of Health (DOH) and the Department of Financial Services (DFS).

Step 1: Check that your plan is covered

If you get coverage through a job, ask HR whether the plan is fully insured in New York or self-funded. The difference is explained in does insurance cover adult ADHD care in New York.

Step 2: Ask the insurer for help and keep a record

Insurers must have dedicated staff to help members find in-network behavioral health providers. On request, the plan must give you a list of available in-network providers within 3 business days. Directories must also show whether a clinician offers telehealth and any restrictions on conditions treated or ages served, which is how you can tell whether a listed psychiatrist sees adults.

Call the member services number on your card and say something like this:

• I need a first outpatient appointment with a psychiatrist or other prescriber who evaluates and treats ADHD in adults. Please send me a list of in-network providers who have availability within 10 business days.

Keep a log: the date, who you spoke to, the reference number, and each office you called with the date and the answer (not accepting new patients, no adult ADHD, first opening in three months). This log is your evidence.

Step 3: File an access complaint with the insurer

If you cannot get an appointment within the standard, tell the insurer, by phone or through its website, that you are filing an access complaint. Use those words.

• I am filing an access complaint under New York's behavioral health network adequacy rules. I have not been able to get an in-network appointment for an adult ADHD evaluation within 10 business days. Here are the providers I contacted.

What happens next:

1. The insurer has 3 business days to locate an in-network provider who can treat your condition and is a reasonable distance from you.
2. The clock resets. Once the insurer receives your complaint, the 10-business-day window starts again, so the appointment the insurer finds may be up to 10 business days out.
3. If no in-network provider is available, the insurer must approve a referral to an out-of-network provider.

You also have the right to ask for an in-person appointment if you do not want telehealth.

Step 4: If an out-of-network referral is approved

Three points decide how useful the approval is.

• Who you can see. The out-of-network provider must be one that does not charge excessive or unreasonable rates. You cannot name any psychiatrist you like and require the plan to treat the visits as in network. Ask the insurer which providers it will approve, or propose one and ask for a written decision.
• What you pay. Your copayment, coinsurance and deductible are the same as if you were seeing an in-network provider.
• How long it lasts. DFS says an approved referral stays in effect until the services are no longer medically necessary or the insurer finds a suitable in-network provider, unless a transition would be harmful.

Get the approval in writing before the first visit, including the provider's name and the dates covered. The mechanics of ordinary out-of-network claims, where no approval exists, are different and are covered in how out-of-network reimbursement works.

Step 5: If the insurer does not act

Take the complaint to the regulator for your type of coverage. Phone numbers below are as printed on the DOH/DFS fact sheet dated July 1, 2025. Confirm them on the agency's own page before you call, because numbers and hours change.

One State web page was found printing the DFS number with a different last digit. The fact sheet and the DFS behavioral health page both print (800) 342-3736.

Free help is available from CHAMP, the State's independent behavioral health ombudsman, at (888) 614-5400 on weekdays or ombuds@oasas.ny.gov. State pages list different hours for the line, so check champny.org. The Attorney General's Health Care Bureau also runs a helpline at 1-800-428-9071.

If the insurer formally denies an out-of-network request, that denial can be appealed, including to an independent external reviewer through DFS. See how to appeal an insurance denial.

What to have ready

• Your member ID and the plan name exactly as printed on the card.
• The call log from Step 2.
• The date you filed the access complaint and its reference number.
• Any written response from the insurer.
• If you have a referral or a prior diagnosis, a copy of it.

While the complaint runs, it is reasonable to keep looking on your own. How long an ADHD diagnosis takes in New York covers what shortens the wait. To ask about an appointment with this practice, see the new patients page; insurance questions are answered on the fees and insurance page.