Overview
In July 2025, the New York State Department of Financial Services (DFS) and the New York State Department of Health (DOH) issued new rules that some New York State health insurers must follow when you are seeking mental health or substance use disorder services.
Through updated behavioral health network adequacy regulations, health insurers must:
- Offer timely appointments
- Help you find in-network behavioral health providers
- Cover out-of-network behavioral health care at no extra cost when in-network care isn’t available
Timely Appointments
You are entitled to see a behavioral health care provider for outpatient mental health and substance use disorder care within the following timeframes:
- Initial outpatient visits within 10 business days, or
- 7 calendar days for a follow-up appointment after being discharged from a hospital or emergency room.
You also have a right to request an in-person appointment with a behavioral health provider that can treat your mental health or substance use disorder condition and is located a reasonable distance from you. That means local, in-person care—not just telehealth, with a behavioral health provider who can treat you.
Help Finding In-Network Providers
Insurers must have dedicated employees who can help you find an in-network provider for mental health or substance use disorder care. Information on how to contact these employees directly, including a telephone number, must be available on your insurer’s website.
If you would like to research in-network behavioral health care provider options on your own, you can review your insurer’s provider directory. The behavioral health provider directory must contain:
- A behavioral health care provider’s location
- The services provided
- Telehealth options
- Languages spoken
- Any restrictions for the conditions treated or ages served
- Facility affiliations
If the behavioral health care provider is a facility, the directory must provide details regarding the level of care ordered, such as inpatient, outpatient, or partial hospitalization.
If you cannot find a behavioral health appointment in the required 7- or 10-day timeframe, you can file an Access Complaint:
- Contact your insurer: Call, or follow instructions online or in your health insurance policy and inform your insurer that you cannot get an appointment within the required timeframe and would like to file an Access Complaint.
- Receive a Response: Whether you reach out by telephone or email, your insurer must provide you with the name and contact information of available in-network behavioral health care providers within 3 business days of your request. This means that your insurer must find an in-network health care provider to see you in the 7- or 10-day timeframe from when your insurer contacts the provider.
Covered Out-of-Network Care
If no in-network behavioral health care provider is available after you file an Access Complaint, your insurer must approve care from an out-of-network provider who can meet the appointment wait times.
If you are approved to see an out-of-network provider because in-network care is not available:
- Your copay, coinsurance, and deductible must be the same as if you stayed in-network
- There are no added or surprise charges
This ensures cost is never a barrier to getting care.