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Talking About Money Without Losing the Relationship
Nothing sours a visit faster than a billing surprise. Patients want to know costs up front, federal law requires good faith estimates for self-pay patients, and membership practices live or die on whether members understand what their fee buys.
Start here: the questions this brief answers
Tap a question for the short answer, then jump to the evidence.
Money conversations are part of the patient experience. In a national survey, 77% of adults said knowing the cost before a procedure is important, yet only 18% said a provider had discussed financing options with them. Since January 2022, the No Surprises Act has required providers to give uninsured and self-pay patients a good faith estimate for scheduled services, on a set timeline, and on request. CMT's books are full of billing stories that broke trust: a wall of all-caps fee signs, a $21 collection letter, a $39 add-on charged after the patient said no. Explain fees in plain words before care, put it in writing, call instead of mailing, and make sure every member can say in one sentence what their membership buys.
“Money conversations aren't awkward because of the money. They're awkward because of the surprise. Tell people the truth up front, in writing and in plain words, and most of the tension disappears.”
Do patients want to talk about cost up front?
Yes. In a national survey, 77% said knowing the cost before a procedure is important, but only 18% said a provider had discussed financing options with them.
Go to the full answer ↓Do good faith estimates apply to membership practices?
The No Surprises Act requires providers to give good faith estimates to uninsured and self-pay patients for scheduled services and on request. Ask counsel how it applies to your membership and non-member services.
Go to the full answer ↓What breaks trust fastest?
Surprises: charges the patient didn't expect, add-ons they declined, and collection letters instead of a phone call.
Go to the full answer ↓How should we explain the membership fee?
In one plain sentence about what it buys, backed by a written summary. Concierge practices that bill Medicare must also follow Medicare rules on what the fee can cover (Brief No. 33).
Go to the full answer ↓Patients want the money conversation
Many clinicians avoid talking about money. Patients wish they wouldn’t.
In a national survey of 1,011 adults, 77% said it’s important or very important to know the cost before a procedure, and 53% wanted to discuss financing options before care. Only 18% said a provider had discussed financing options with them in the past two years.1 Industry Research
Confusion about bills is part of what’s wearing patients out. A 2023 Ipsos survey for MDVIP found 61% of adults 26 and older called the U.S. health system a hassle.2 Population Data
Good faith estimates for self-pay patients
Since January 1, 2022, the federal No Surprises Act has required providers and facilities to give uninsured and self-pay patients a good faith estimate of expected charges. The California Medical Association’s summary of the timing:3 Policy and Law
| When the service is scheduled | Estimate due |
|---|---|
| At least 10 business days ahead | Within 3 business days of scheduling |
| At least 3 but not more than 10 business days ahead | Within 1 business day of scheduling |
| Any time the patient asks | On request |
Source: California Medical Association summary of the No Surprises Act requirement.3 The CMA noted the requirement applies to all providers, not only those out of network.
Membership practices often provide some services under the membership and others for separate fees, and some patients use insurance for other care. How good faith estimate rules apply to each depends on the facts. Have a healthcare attorney review your process. This brief is educational and is not legal advice.
How money conversations go wrong
When Michael Tetreault’s family walked into one specialist’s office, the sliding glass window was surrounded by all-caps signs about bill payment, card fees and extra charges. They left in less than three minutes. “Nothing sprouts faster and raises frustration and confusion levels between your Staff and patients than the topic of billing.”
From No More Waiting Rooms (2024).4
Michael’s wife declined a $39 add-on at check-in, was charged for it anyway at checkout (“you signed the form”), and then was told her insurance would have covered it.
From No More Waiting Rooms (2024).4
The book’s billing advice starts simply: “Don’t send a letter six weeks after the Patient last visited the practice threatening collections for $21; pick up the phone.” Then: explain benefits, non-covered services and pre-authorizations clearly; anticipate problems; and never let staff talk down to a patient about a bill.
From No More Waiting Rooms (2024).4
Make the membership fee easy to explain
One sentence
“Your membership covers ___, so you can ___.” Every team member should be able to say it.
One page
A plain-language summary of what's included, what costs extra and how billing works, reviewed by counsel.
Before, not after
Discuss any separate charge before the service, in writing, with an estimate.
Call, don't mail
For any billing question or balance, a person calls first.
Concierge practices that stay enrolled in Medicare may charge a membership fee only for services and amenities Medicare does not cover. Brief No. 33 explains the rules. Have your membership agreement reviewed by a healthcare attorney.
| Instead of | Try |
|---|---|
| A sign: “PAYMENT IS DUE AT TIME OF SERVICE.” | A conversation: “Before we start, here’s what today will cost and how you can pay.” |
| “You signed the form.” | “Let’s look at this together. I want to make sure you’re only charged for what you agreed to.” |
CMT original examples.
Clarity is hospitality
- Take down any all-caps billing signs and replace them with one friendly, clear note.
- Write your one-sentence membership description and test it on three members.
- Ask your attorney to review your good faith estimate process.
A clear, honest message about what members get is the heart of community marketing. Test yours in the planner's message check.
Free. No sign-up. Your answers stay in your browser. Step 3 of CMT's Learn, Build, Lead tools. It helps you pick the patient segments that fit your practice, find where they are, plan conversations with local physicians, check that your message sounds like care rather than a pitch, and leave with a 90-day plan.
This brief is educational and is not legal, financial or tax advice. Billing, Medicare, No Surprises Act and state consumer rules may apply. Consult qualified advisers.
They want to know
77% want the cost before a procedure.
Follow the rules
Good faith estimates for self-pay patients.
No surprises
Explain first, in writing, then call if anything changes.
How this brief was built
This brief draws on a 2017 national patient survey commissioned by a patient financing company and conducted by ORC International (labeled Industry Research), a California Medical Association summary of the No Surprises Act good faith estimate requirement, a 2023 Ipsos survey for MDVIP, and stories from CMT's books. Legal summaries are general; how the good faith estimate rules apply to membership fees and services should be confirmed with counsel.
How to read the evidence types
Every key finding is labeled by evidence type. Labels describe the type of evidence, not its value. Each type answers different questions. Funding is disclosed on every source.
Randomized trials and systematic reviews.Best for cause and effect.
Large observational studies and government data.Best for trends at scale.
Surveys, smaller studies and expert consensus.Best for real-world experience.
Company-sponsored or company-reported data that is not peer-reviewed.Best for early signals and operating data.
Statutes, regulation and official guidance.Best for what is required.
What we don't know
- How patients' expectations about cost conversations have changed since 2017.
- How regulators apply good faith estimate rules to specific membership arrangements.
How to cite this brief
External review: this brief has not yet been reviewed by an outside expert. When review is complete, the reviewer is credited by name above with any conflicts of interest, and the version number is updated. Reviewers check accuracy and fairness; CMT is responsible for the final content.
Corrections policy: when an error is identified, CMT corrects it in the open and updates the version number above. Send corrections to the editor through conciergemedicinetoday.net.
Related CMT Research Briefs
References
- Healthcare Finance News. Yes, patients want to discuss pricing and payment options before treatment (HealthFirst Financial patient survey by ORC International, 1,011 U.S. adults). September 13, 2017. www.healthcarefinancenews.comFunding: not stated (news report); survey commissioned by HealthFirst Financial, a patient financing company
- MDVIP. Patient frustration surges: Americans struggle with broken healthcare system (Ipsos KnowledgePanel survey of 1,010 U.S. adults 26 and older, December 1 to 10, 2023; margin of error plus or minus 3.2 points). Press release. February 27, 2024. www.mdvip.comFunding: industry (MDVIP press release; survey conducted by Ipsos)
- California Medical Association. New federal law requires all physicians to provide good faith estimates to uninsured and self-pay patients (No Surprises Act, effective January 1, 2022). January 24, 2022. www.cmadocs.orgFunding: not stated (state medical association publication)
- Tetreault M. No More Waiting Rooms: A Customer Service Road Map to Help Remarkable Medical Offices Navigate Their Way Towards an Irresistible Practice Where Gratitude Is on Repeat. Concierge Medicine Today, LLC; 2024. Stories are the author's own experiences and accounts told to the author.Funding: Concierge Medicine Today (self-published; no outside funder) CMT original
Educational and informational only. This CMT Research Brief does not constitute medical, legal, tax, financial, accounting or other professional advice, and it does not create a professional relationship of any kind. Statements about laws, regulations, tax rules and payer policies are general, may not reflect the rules in your state, and can change after publication. Consult a qualified attorney, accountant, tax adviser, compliance professional or licensed clinician before acting on anything here.
Independence. Concierge Medicine Today is an independent publication. It does not accept payment for favorable coverage, and it does not favor one practice model over another. Company names and products are mentioned for context only and are not endorsements. Funding is disclosed for every source in the reference list.
Accuracy. CMT verifies figures against their original or best available sources at the time of publication. Where a figure is an estimate, an inference or a company-reported number, the brief says so. This content is not without possible error or omission.
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