5 Steps to Handle the "Wait... You DON'T Take My Insurance?" Conversation
“If you tell the truth, you don’t have to remember anything.”
-Mark Twain
Today’s TLDR: how a clinic should say that it does not accept insurance
Let the patient talk after you greet them tactfully
Set clear appointment expectations based on what the patient needs—this would include giving a quote/estimate
Frame the benefits of your clinic (e.g. more time spent, unique expertise) properly
Imagine an appointment call where the conversation goes beautifully…
…until you say “our provider/Dr. XYZ doesn’t accept your insurance.” Then you get hit with one of the following:
“Oh, I can’t do that.”
“I pay for my insurance already, why should I do this?”
*patient hangs up the phone*
“What do you mean no insurance plans?”
“Why the **** would I come here?”
“I’ll talk to my spouse/partner/family first”—> READ: they ain’t calling back!
Now picture that happening 15 times in a row in the span of 20 minutes. No wonder your office manager’s so irritable today. Fear not! Use the power of framing. A few minor changes in script raises the odds that more of those 15 opportunities convert into happy patients.
Framing
Here’s the script guideline I’ve used over the last five years for new patient calls. Shape this around your clinic and specialty.
Your usual greeting, regardless of intent e.g. “Good morning, this is Dr. XYZ’s office”
Let the patient talk—and listen to them… or ask “how can I help you?” to prompt more conversation
You could also say “why don’t you walk me through what you’d like help with and we’ll go from there?”
If this is meant to book a visit: ask if the patient is established or not.
If established, get relevant intake, book the appropriate appt, give a quote, etc.
Set expectations before patients step foot in the building. I tweak this for each patient. But here’s a common example response.
“Based on what you’re telling me, I’d book you for a 30min visit—the reason why I say that is so there is enough time to do a complete exam, have Dr. XYZ take pictures, and go over options for treatment, etc. If you need a biopsy there will be enough time to handle that so you won’t need to make two trips to the clinic.”
Make it clear, with context, that your clinic offers way more benefits than an insurance-based office. As mentioned in past articles, this should be an investment for the patient, not an expense.
Walk through the out-of-network setup
Now for the sensitive part. “The other important thing I want to go over with you is the fact that Dr. XYZ does not accept any insurance plans—that being said, we always give quotes and estimates to patients ahead of time so there are no surprises. I wanted to make sure we go over this before planning anything else.” Avoid a tone that makes this sound like a problem.
It’s best to deadpan this and not rush the conversation. Let the fact you’re out of network sink in with the patient. Going too fast comes off as insincere. Avoid interrupting if possible
“I always make sure to cover this with new patients.”
Have a process in breaking down prices. With fee-for-service models, it can be effective to give a range for consults and a precise number for procedures. For example: “we usually bill $300-$400 for a consult regarding what you’d like help with. If you need a biopsy we bill $150 per location.” Membership-based practices like direct primary care clinics might instead discuss what’s included (and not included) in any dues.
It’s also helpful to stress that medications and lab orders are still processed by insurance (with the exception of orders made by out of network providers for Medicaid members).
5. Close out the call per your clinic’s appointment policies and intake
a. Don’t waste time with new patients having an outburst who clearly don’t want to make an appointment. If your clinic is not a good fit for the patient but another clinic is (whether unrelated to your specialty or not), build a little goodwill. Send the patient to where he/she needs to go. Let these unruly pitches go by you and take the walk instead. But unlike in baseball, there’s no three-strike system on the clinic phones. Each contact matters.
Ingrain these guidelines among your staff answering the phones
Avoid being too prescriptive—allow some leeway in phrasing. Let your team’s natural voice take over. Mold these elements to the nature of the clinic. A dermatologist’s scheduling team would run a calendar differently than a general surgery practice. Patients will detect canned responses. Of course, if you have a target demographic, these issues recede. Aim to convert ~40-50% of “on-the-fence” new patients (i.e. they aren’t a searing or freezing lead) to appointments that are ultimately kept.
Run the Silence Test
How do you know the call went well? It goes beyond the visit itself. If the staff did their job right, the physician shouldn’t have to say a word about billing in the exam room (barring emergent circumstances). Patient fee expectations should remain stable from arrival to departure. Contact me on Substack or @caretocash on x.com to address specific questions for your practice, or talk shop.