Insurance Routing

Once you've collected basic qualifying information, you must route the caller based on their insurance type. This is a critical decision point.

Commercial Insurance Path

Qualifications:

Insurance is through employer or privately purchased (not state-provided)
Major carriers: Blue Shield, Blue Cross, Aetna, Cigna, United Healthcare, etc.

Your Process:

Step 1: Collect insurance information

Company name
Member ID

Step 2: Ask employment verification

"Is that through your employer or is it state-provided?"

Step 3: If commercial, proceed to rapport phase

"So, tell me a little bit about what you're struggling with."

Step 4: While they talk:

Verify insurance in background
Put details in admissions thread
Check if Closer is available

Step 5: Once they finish, transition to transfer

"Once they finish, let them know you are going to put them on a brief hold and transfer the caller to the senior admissions coordinator."

Step 6: Execute transfer

Mute the call, quick prep with Closer, then transfer

Step 7: Post-transfer documentation

Complete a chart within the CRM
Score the call

Medicaid/Medicare Path

Qualifications:

Medicaid (state-provided)
Medicare (federal senior/disability insurance)

Your Process:

Step 1: Confirm they don't have other insurance

"Are you sure you don't have any insurance through a job, family, or that's paid for monthly?"

Step 2: Explore self-pay capability

"Do you or your family have the means to self pay? Or are you dependent on your Medicaid/Medicare?"

Step 3: If dependent on Medicaid/Medicare

"Let them know we do not take that insurance and we will have a facility that does call them ASAP."

Step 4: Send information to partner facility

Collect their contact information
Send to Medicaid/Medicare partner facility
Set expectation for callback timeframe

Self-Pay Path

Qualifications:

Caller has no insurance
Caller has financial means to pay out-of-pocket
Caller prefers not to use insurance

Your Process:

Step 1: Confirm self-pay intention

Ask directly about their financial situation without making assumptions.

Step 2: Proceed to rapport phase

"So, tell me a little bit about what you're struggling with."

Step 3: While they talk

Check Closer availability
Note self-pay status in CRM

Step 4: Once they finish, transition to transfer

"Let me put you on a brief hold and transfer you to the senior admissions coordinator."

Step 5: Execute transfer

Mute, prep Closer with self-pay status, transfer

No Insurance, No Money Path

Qualifications:

No insurance
No financial means for self-pay
No family support for payment

Your Process:

Step 1: Confirm situation

Verify they have no payment options without making them feel judged.

Step 2: Provide grant-based options within their state

Offer specific resources that accept uninsured patients or state-funded programs.

Step 3: Position as resources, not rejection

"I understand. We do require either insurance or self-pay for our programs. But there are grant-based and state-funded options in [their state] that might be able to help. Let me get you connected with those resources."

Insurance Routing Quick Reference

Insurance Type	Action	Next Step
Commercial Insurance (Blue Shield, Aetna, Cigna, etc.)	Collect info → Verify → Rapport	Transfer to Closer
Medicaid/Medicare	Confirm no other insurance → Explore self-pay	Refer to partner facility
Self-Pay	Confirm ability → Rapport	Transfer to Closer
No Insurance/No Money	Confirm situation	Provide grant-based options

Special Considerations

In-Network vs Out-of-Network

VOB (Verification of Benefits) Handoff

If insurance verification takes longer than expected, you may need to:

Complete the initial qualification
Tell the caller you'll verify benefits and call them back
Hand off to VOB team for detailed verification
Follow up once benefits are confirmed

Mixed Insurance Situations

Scenario: Caller has Medicaid but family can supplement with self-pay

Response: "Okay, so you have Medicaid, but your family can help with additional costs. Let me talk to our admissions coordinator about whether we can work with that combination. Are you calling for yourself or a loved one?"

This becomes a Closer decision, not an Opener decision. Transfer and let the Closer explore options.

Example Routing Scenarios

Scenario 1: Commercial Insurance

You: "What insurance company is that?"

Caller: "Blue Cross Blue Shield."

You: "Is that through your employer or is it state-provided?"

Caller: "Through my employer."

You: "Perfect. I'll verify that for you while we talk. So, tell me a little bit about what you're struggling with."

Scenario 2: Medicaid

You: "What insurance company is that?"

Caller: "Medicaid."

You: "Okay. Are you sure you don't have any other insurance through a job, family, or that's paid for monthly?"

Caller: "No, just Medicaid."

You: "Do you or your family have the means to self pay? Or are you dependent on your Medicaid?"

Caller: "I'm dependent on Medicaid. I can't afford to pay out of pocket."

You: "I understand. We don't take Medicaid, but I'm going to connect you with a facility that does. They'll call you within the next couple hours. Can I get your contact information?"

Scenario 3: Self-Pay

You: "Do you have insurance you're wanting to utilize?"

Caller: "No insurance. I'll be paying out of pocket."

You: "Okay, so self-pay. Got it. So, tell me a little bit about what you're struggling with."

← Previous: Wrong Facility Objection Next: The Handoff to Closer →