The insurance question will come up nearly every day for you as a direct primary care pediatrician. When your office phone rings and the first thing a potential patient asks is, “Do you take insurance?” how you respond can make all the difference. Even if your website clearly explains your payment model, this question will come up frequently. A simple “no” often leads to callers quickly moving on, without giving you a chance to explain the benefits of your Direct Primary Care (DPC) practice. Whether you’re a solo practitioner or have staff, having a professional and well-thought-out plan for answering this question is important.
As a former DPC pediatrician, I also highly recommend setting up an automated system to address this question or to schedule “meet and greet” discussions. Without such a system, you could spend a significant portion of your day repeatedly explaining your practice model. As the most valuable asset in your practice, you need to focus your time on other essential tasks. You don’t want to rebuild the rat wheel and burn out by not having a repeatable process in place.
Here are three key areas to focus on when crafting your response to the insurance question.
Convey the Value of Direct Care
Instead of telling people what you don’t do, which is accept health insurance, focus on what you actually do. Don’t let them focus on the insurance question. You are offering a very different practice model that does not focus on insurance.
Increased Access & Availability: Emphasize longer, unhurried appointments, same-day/next-day scheduling. Direct access to the physician via text, email, or phone. Access leads to fewer expensive urgent care or ER visits.
Personalized, Comprehensive Care: Explain how not dealing with insurance paperwork frees you up to focus entirely on their child’s health. Without all of the insurance headaches, I can offer proactive wellness, preventative care, and a deeper understanding of your family’s needs.
Cost Transparency & Predictability: Clearly articulate the straightforward monthly membership fee and what it covers. You can contrast it with the unpredictable co-pays, deductibles, and surprise bills often associated with insurance-based models.
Empowerment & Advocacy: By not accepting health insurance, you can position yourself as an unencumbered advocate for their child’s health. You make decisions based solely on medical need rather than insurance dictates.
Validate Concerns and Educate on Benefits
It is normal for a parent to initially feel concerned because you do not take insurance. They are imagining all of the extra money out of pocket that they will be spending on their child’s medical care. Say something that tells them that you understand their concerns and then go on to explain what the benefits of joining your practice would be for their family.
In certain situations, the family may be spending more on their children’s health care by choosing your practice. But instead of completely focusing on the actual dollars and cents, help them to understand what health care costs really look like and let them draw their own conclusions for their specific family situation.
Break Down the “Real” Cost: Explain that while there’s a monthly fee, many families find DPC ultimately more cost-effective for many reasons. Due to the fact that you have more time to spend on their child’s visits, you are less likely to refer things to specialists. You can also save them money by reducing the number of times that they would need to go to urgent care or be seen in the ER. When I had this discussion with families, I would give them some examples of times where I was able to help a family in the practice to avoid an ER visit because I was able to stitch their child’s laceration up at their house.
The Role of High-Deductible/Catastrophic Plans: You shouldn’t get too deep in the weeds about insurance plans since you are not an insurance agent, but you can educate parents on how your DPC practice pairs well with certain types of insurance plans. High deductible insurance plans are becoming more and more common. Families without big medical needs will not likely meet their deductible in any given year and the cost of your practice would potentially be less than they would spend elsewhere. In addition, DPC can pair well with catastrophic plans or health sharing plans (which are not true insurance). If they are interested in your practice, you can encourage them to speak with their insurance agent to see what they can offer to pair well with your practice.
FSA/HSA Compatibility: You can discuss with families that they may be able to use their HSA for services. I would usually wait for people to bring this up and then explain that it might be possible for them to use their HSA or FSA. As of July 2025, this remains a gray area and you should tread lightly when you are discussing this with potential patients. Encourage them to reach out to their tax professional to verify for their individual situation.
Offer Resources
Instead of simply answering the insurance question and leaving it there, DPC pediatricians should be prepared to guide potential patients through the decision-making process with clear communication and helpful resources.
Anticipate Follow-Up Questions: Have ready answers for common concerns like “What if my child needs to see a specialist?” (explain referral process and potential for direct communication with specialists) or “What about labs/imaging?” (explain negotiated cash prices or how to bill through insurance for these).
Offer a Discovery Call/Meet & Greet: Encourage families to schedule time to talk with you where they can learn more about the DPC model, meet you, and ask all their questions. This allows for a deeper dive than a quick phone call. Just be sure that when you schedule these with families that they are aware that you won’t be able to answer specific medical questions.
Provide Tangible Information: Have readily available materials (brochures, website links, FAQs, testimonials) that detail pricing and included services. I would conclude my phone calls by asking for their email address so that I could send them my pricing sheet with details about the practice. You could also direct them to your website and your enrollment process.
Emphasize Partnership: Explain how the DPC model is a partnership between the family and the pediatrician. Without insurance getting in the way, you have more flexibility and freedom to meet a family’s specific medical needs.
Memorize a Statement
When you start any small business, you need to be able to have your “elevator speech” ready at all times. This is a short and concise summary of what you do. Something that you could deliver to another person in the time that it takes to ride between floors in an elevator.
Here is an example of an elevator speech that you can adopt for your practice as well as some one liners that you can use.
“I’m a pediatrician and own a direct primary care practice. Instead of dealing with insurance companies, I work directly for you and your child. This allows me to offer longer appointments, same-day access, and direct communication with me whenever you need it through texting and calling me directly. My goal is to provide truly personalized, unhurried care where I know your child well. I focus on prevention and can be there for you when it matters most without all of the barriers of an insurance based practice.”
- Our commitment is to your family, not the insurance company.
- You can still use your insurance for most services you’re familiar with like labs, imaging, and prescriptions.
- We work outside the insurance system so we can provide longer visits, direct access to your doctor, and care that’s guided by what your child needs, not what insurance will approve.
- We are a membership based practice. You pay one monthly fee and that covers visits for sick and well care and communication between visits. It’s simple, predictable and we promise not to surprise you with bills later.
DPC for the Win
In all of these discussions, just remember that customers buy benefits, not features. Focus your talk with potential patient families on all of the benefits of your practice. Highlight the peace of mind that comes with direct access to their pediatrician, the improved health outcomes from truly personalized care, and the financial predictability of your model. By consistently communicating this value, you’ll transform a simple “no” into a compelling “yes” for families seeking a better way to care for their children.
Dr. Andrea Wadley is a retired pediatrician. She owned 127 Pediatrics from 2018 to 2024 and now helps other pediatricians to succeed at the DPC model.
