Patient Financial Scripts

File: Office Binder \ Billing & Collections

Marketing Manager System(sm) Marketing Toolkit/ Retention

Financial Consultation Toolkit

Sample Patient Financial Consultation Scripts

The following are sample patient financial scripts.

Important points to remember are that a) we cannot guarantee what the insurance company will pay, b) we do not want finances to be a barrier to care and will work with the patient, and c) we must make a reasonable effort to collect the patient’s co-payment and deductible.

Situation: Patient has seen the doctor, agreed to care, and insurance has been verified. (Good insurance.)

Script: “Mrs. Jones, we called your insurance for you and the good news is that they will cover the majority of your care at the clinic. You have some limits on chiropractic and medical services, but your insurance should pay pretty well. We’ve dealt with this company before and haven’t had many problems. I can’t tell you exactly how they will pay, but normally they will pay around 80% of the care and you have a $250 deductible. What I want to do today is get an amount that you can comfortable afford to pay each visit towards your portion of the care. We’ll bill and follow up on your insurance for you. Usually it balances out in the end once we make adjustments for PPO discounts or write-offs we take, but if you have a credit at that point we’ll refund it to you or we’ll let you know if you have a balance. How much would you like to pay each visit towards your co-insurance?”

Situation: Medicare patient with secondary (not a supplement) has seen the doctor, agreed to care, and insurance has been verified.

Script: “Mrs. Jones, we called your insurance for you and the good news is that they should cover almost all your care between Medicare and your secondary. Our clinic is a Medicare participating provider and that means that we bill Medicare for you, they pay us directly, and we agree to accept Medicare’s reduced fees. Medicare does have some limits on how many visits you can get for each condition, so we will let you know when Medicare stops paying. At that point, if your secondary continues to pay it shouldn’t be a problem, but if you still need care and your insurance stops paying, you and I can get back together and work something out so you can get the care you need. Now Medicare is famous for sending letters to patients that are hard to understand, so if you get anything from them that you want me to go over, I’d be happy to explain it to you. Do you have any questions?”

Situation: Patient has seen the doctor, is uncertain about care, and insurance has been verified.

Situation: Patient has seen the doctor, not agreed to care, and insurance has not been verified.

Script: “Mrs. Jones, I understand you had some questions about treatment before you want to get started. Do you have any questions about the care you need or what the doctor discussed with you? (If yes, stop and get the doctor – do not go on.) Are your concerns about how you’ll be able to afford care? Well I can totally understand that. Our clinic policy is to work with patients so that finances are not a barrier. What is your insurance company? Oh, ABC Insurance. Well, from what I have seen in the past, they do cover the majority of the care here, but let me have a copy of your card and I’ll give you more specifics on what they cover on your next visit. (-- OR: Oh, ABC Insurance. Never heard of them, but my experience has been that almost all insurance covers the care at our clinic. Your co-pay is generally between $5 and $15. Let me have a copy of your insurance card and I will verify your specific plan for you and fill you in on your next visit.) (-- OR: Oh, ABC HMO. Well, I can tell you we are not on their provider panel, but we have our own plan that sets your co-pay exactly the same as an in-network provider. From there we accept what ABC pays as payment in full on your bill. Does that handle your concerns?) You may have some limits on chiropractic and medical services, but your insurance should pay pretty well. We’ve dealt with this company before and haven’t had many problems. I can’t tell you exactly how they will pay, but normally they will pay around 80% of the care and you have a $250 deductible. What I would do for you today is get an amount that you can comfortable afford to pay each visit towards your portion of the care. We’ll bill and follow up on your insurance for you. Usually it balances out in the end once we make adjustments for PPO discounts or write-offs we take, but if you have a credit at that point we’ll refund it to you or we’ll let you know if you have a balance. How much could you pay each visit towards your co-insurance?”

Situation: Patient has seen the doctor, agreed to care, and no insurance.

Script: “Mrs. Jones, I understand you want to get care, but have no insurance. Normally an office visit will run between $32 and $165 depending on what the doctor orders. Is that going to be a problem? We do offer a discount for payment at time of service and we also accept credit cards. (If there is a financial hardship, see the script in the “Fee Consideration” policy and form.)

Situation: Patient has seen the doctor, agreed to care, and insurance has been verified, insurance plan provides little or limited coverage. (DC/MD clinic).

Script: “Mrs. Jones, we called your insurance for you and the good news is that they will cover some of your care at the clinic. They have limits on therapies and they will not cover the chiropractic. Because we have a medical doctor supervising care, they will cover your medical services. We’ve dealt with this company before and know what to expect, so we haven’t had many problems. Generally what we do is provide you as much therapy, including the chiropractic adjustments, as the doctors feel you need. We will submit it all to your insurance and will write off the therapies they don’t cover. Usually they only cover three therapies, so we would not charge you for the fourth therapy if you need it and the insurance disallows it. This way we work within your policy, provide the care the doctor feels you need, and keep the care affordable for you. What I need to do today is get an amount that you can comfortable afford to pay each visit towards your portion of the care – this would be for the co-pay and deductibles that they don’t cover. We’ll bill and follow up on your insurance for you. Usually it balances out in the end once we make adjustments for non-covered services or discounts, but we’ll let you know if you have a balance. How much would you like to pay each visit towards your portion?”

Additional policy references and scripts should be reviewed, including: Post Report (Procedure for Checking Out Patients After the Report of Findings), Setting Up Finances, and Fee Schedules. These should be in your manual or are available from our office.

David Michel

Petty, Michel & Associates