Have you tried teaching hospitals? They usually accept nearly any insurance and while you may get a pdoc resident instead of a pdoc that resident is working under a pdoc and at least where I go you see the supervising pdoc at least sometimes. I think where I go alway uses PAs but I don't think they use PNPs although I'm not sure. Where I go has a pretty amazing charity care program; they actually covered all my medical costs during the 2 years I was not insured and that included a hysterectomy. They provide 100% up to a certain point and then if your income is at certain levels they'll reduce your cost a certain amount. They will also provide partial help if your income is below certain levels and you are needing help. If I have to do IP I'll probably be applying for that since I'm still paying my medicaid spenddown from surgery last year and will have a 2nd spenddown from the IP stay. (Makes me anxious thinking about it). I was already with my pdoc when she moved there so I don't know how the new patient process works but with other departments I've just called an appointment line, am given an appointment that is usually fairly soon if I'm not requesting a specific dr and when it's time I go. Medicare covers where I go for a session coded as I think 45-55 minutes. The co-pay still stinks because it is not cheap, about $30 per month plus gas because it's 2.5 hours away, but I have a good dr, consistent care and I doubt I could find anyone a lot closer to take me. And I've had much worse deductibles, $50/month for a while and I think even more than that before mental health parity act (I had to pay 60% or 75% of something). Before I started with this dr I tried to get someone in the city where I lived then and still go for therapy. 5/6 doctors wouldn't take a bipolar patient and the 6th put me on a waiting list. 13 years later I'm beginning to think they aren't going to call....