Parents of children with long-term emotional or behavioral conditions often struggle to access and afford mental health services for their children. This article examines the parent-reported reasons for unmet mental health needs in children using the National Survey of Children with Special Health Care Needs, specifically investigating whether insurance status (insured versus uninsured) and insurance type (private versus public) influences why a child has an unmet mental health need. The sample included children whose parents reported a need for mental health care or counseling in the previous 12 months, focusing on children with long-term emotional/behavioral problems rather than children experiencing episodic events that might only require short-term mental health services. Findings indicate that being uninsured increases the likelihood of parents reporting costs too much as the reason for their child having unmet mental health needs, whereas being insured by public health insurance decreases the likelihood of reporting costs too much as the reason. Policy implications include the need for expansion of health insurance coverage for all children and the need to achieve parity for mental health benefits in private health insurance.