Top 6 questions patients have about billing and insurance (and how to answer them)

Medical billing and insurance processes can be complex — and for many patients, confusing. Even those with years of experience navigating healthcare often feel uncertain about what to expect when it comes to costs, coverage, and claims.

Private practices that take time to clearly answer common billing questions not only reduce administrative back-and-forth — they also build trust and satisfaction that keep patients coming back.

Here are the 6 most common billing and insurance questions patients ask, and how your team can proactively address them.

This is the top billing question most patients have — and often the hardest one for front desk teams to answer with confidence.

Patients want clarity: Are they responsible for a co-pay, deductible, coinsurance, or all three? And how much will it actually be?

How to answer it:

Verify benefits in advance using your EHR or billing software’s eligibility tools. Tools like Tebra’s built-in eligibility verification simplify this step and help practices give patients more accurate estimates in advance.

Then, provide patients with a clear explanation — ideally via email, phone, text, or patient portal — before their appointment.

Pro tip:

Avoid vague terms like “it depends” or “we won’t know until the claim processes,” as this does little to alleviate worries.

Instead, say something like:

"Based on your insurance, you’ll likely owe a $30 co-pay at check-in. If your deductible applies, we’ll send you a bill after the visit for any additional amount."

Many patients assume the cost of care begins and ends with their office visit. But when labs, imaging, or third-party services are involved, unexpected bills can create confusion — and frustration.

How to answer it:

Be transparent upfront. If your practice sends out labs or refers patients for imaging, let them know those services are billed separately — even if they’re ordered by a provider.

What to say:

"During your visit, your provider may order labs. Those tests are billed directly by the lab company, so your insurance may process those separately from your visit here."

“One surefire way to make your patients angry is to have them receive unexpected additional bills in the mail”, says Dr. Jesse Houghton, MD, FACG, senior medical director of Gastroenterology at Southern Ohio Medical Center. “Taking extra time to make billing expectations clear will prevent your practice from losing patients due to this common issue.”

Patients don’t always understand the limits of their plan, or whether a specific service will be covered. They often turn to your practice for clarity.

How to answer it:

If you offer insurance verification, let patients know what’s included and what’s not. If you don’t offer it, be upfront and suggest the best next step.

What to say:

"We’ll verify your coverage and check eligibility for the visit type before your appointment. For specific questions about benefits like mental health or specialist visits, we recommend calling your insurance directly."

Tip:

Automate benefit verification and share summaries through your patient portal so patients feel informed before they arrive.

Insurance denials create stress — especially if patients feel they’re on the hook for unexpected charges.

How to answer it:

Explain your process clearly. Let patients know your team will handle denials first, and when (if ever) they’ll need to follow up.

What to say:

"If your claim is denied, we’ll review it and handle any resubmissions or appeals we can. If we need information from you, we’ll contact you with clear instructions."

This question may seem basic, but it reflects past patient experiences, especially for out-of-network or cash-based services.

How to answer it:

Be clear about what your practice handles and when a patient may need to submit a claim independently.

What to say:

"We’ll bill your insurance directly. Once the claim is processed, we’ll send you a bill for any remaining balance based on your coverage."

If you offer self-pay or out-of-network care, use tools at your disposal to help patients submit their own claims.

It’s a common mix-up. While related, these terms refer to different requirements — and not all patients know when they apply.

How to answer it:

Offer a clear, concise explanation and let patients know you’ll support them through either process.

What to say:

"A referral comes from your primary care provider and is usually required to see a specialist. Pre-authorization is your insurance company’s approval for a specific test or procedure. We’ll help coordinate both if needed."

“As a specialty practice, our office has to make it clear to our patients that pre-authorization is a necessity when prescribing expensive medications or scheduling procedures”, says Houghton. “We have certain staff assigned to this process so nothing slips through the cracks.”

Patients don’t expect billing to be perfect — but they do appreciate clarity, consistency, and options. The right systems make that possible.

With features like automated eligibility checks, integrated patient payments, and claims tracking tools, platforms like Tebra can give practices the support they need to answer tough questions, reduce billing friction, and deliver a more patient-friendly experience.

Tip:

Use digital intake forms, reminders, and your portal to share billing policies and cost expectations upfront, so you reduce surprise bills and improve collections.

Want more strategies for reducing billing confusion and boosting patient trust? Explore how practices use Tebra to simplify payments, automate claims, and stay financially healthy while putting patients first. Book a personalized demo today.