Your marketing team delivers a steady stream of leads. But somewhere between the form submission and the treatment start date, most of them disappear.

You blame marketing. “The leads aren’t qualified,” you say.

But here’s what’s actually happening: Your clinic doesn’t have a structured qualification process. You’re relying on unstructured phone conversations where different coordinators ask different questions, miss critical information, and make inconsistent qualification decisions.

One coordinator books someone who doesn’t meet clinical criteria. Another dismisses a perfectly qualified lead because they didn’t ask the right questions. A third forgets to verify insurance, so a qualified patient gets shocked by costs after their first appointment.

The problem isn’t the leads. It’s the process.

Why Unstructured Phone Conversations Fail

When a lead calls your clinic (or your coordinator calls them back), what typically happens?

Unstructured conversation:

Coordinator: “Hi, how can I help you?”

Lead: “I’ve been depressed for years and my doctor said I should try TMS.”

Coordinator: “Great, we do TMS. When would you like to come in?”

Lead: “Maybe next week?”

Coordinator: “Perfect, I have Wednesday at 2 PM.”

What information was NOT gathered:

  • Have they actually failed adequate antidepressant trials? (Insurance won’t cover if they haven’t)
  • Do they have metal implants? (Contraindication for TMS)
  • What’s their insurance? (Can they afford this? Will it cover?)
  • Are they in crisis? (Should this be routed to emergency resources?)
  • Do they have realistic expectations about cost and timeline?
  • Are they actually motivated to complete treatment, or just exploring?

The coordinator answered one question: “Can we schedule them?” But that’s the wrong question. The right question is: “Are they actually qualified?”

The lead gets booked. The psychiatrist spends 45 minutes in intake, discovers the patient hasn’t failed enough antidepressants, and can’t recommend TMS. Appointment wasted. Patient disappointed. Insurance argument follows.

This cycle repeats across dozens of leads per week.

Compare this to what should happen:

Structured 5-step qualification process:

  1. Intake Information Gathered → Demographic, diagnosis, symptom details, current medications
  2. Insurance Verification → Real-time eligibility check, prior auth requirements, cost estimation
  3. Clinical Criteria Assessment → Meets TMS/Spravato/treatment criteria? Any contraindications?
  4. Appointment Readiness Confirmed → Timeline expectations, cost understanding, motivation assessed
  5. Coordinator Handoff → Pre-qualified lead sent to coordinator with all information ready

Each step is systematic. Each step uses consistent criteria. Each step qualifies the lead more thoroughly before it reaches your psychiatrist.

Step 1: Intake Information Gathered

The Goal: Collect comprehensive demographic and clinical information that informs all subsequent qualification steps.

What gets gathered:

Demographic Information:

  • Name, contact info, date of birth
  • Insurance type, member ID, group number
  • Employer (relevant for insurance and benefits)
  • Referral source (how did they find you?)

Presenting Concerns & Diagnosis:

  • Primary complaint (depression, anxiety, etc.)
  • Duration of current episode
  • Severity (mild, moderate, severe)
  • Functional impact (work, relationships, sleep, appetite, etc.)

Psychiatric History:

  • Previous diagnoses
  • Hospitalization history
  • Suicide attempts or self-harm history
  • Any psychotic features or bipolar history

Medication/Treatment History:

  • Current medications (including antidepressants, doses, duration)
  • Previous antidepressant trials (names, doses, how long, why discontinued)
  • Previous therapy experiences
  • Previous TMS, Spravato, or other neuromodulation

Medical History:

  • Non-psychiatric medical conditions
  • Implanted devices (pacemaker, cochlear implant, etc.)
  • Metal implants (bullets, shrapnel, metallic objects near brain)
  • Seizure history or epilepsy family history
  • Substance abuse history
  • Pregnancy status (if applicable)

Current Status:

  • Suicidal ideation? (Severity: passive ideation vs. plan vs. intent)
  • Homicidal ideation?
  • Hospitalization history
  • Treatment goals (what does the patient hope to achieve?)

The difference from unstructured conversation: An unstructured call might pick up 3–4 of these data points. A structured intake captures all of them, or clearly documents what’s missing and needs follow-up.

How it’s collected: Via intake form (online or paper), phone screening call, or AI-assisted intake system.

Red flags that emerge at this stage:

  • No documented psychiatric diagnosis
  • Unclear medication history
  • Possible active suicidal/homicidal ideation
  • Implanted medical device
  • Significant substance abuse
  • Severe untreated medical conditions
  • Pregnancy (if relevant to treatments considered)

Any of these flags might require additional screening or immediate triage to psychiatric emergency services—not scheduling for a routine consultation.

Result: A complete intake profile. The lead moves to Step 2 with comprehensive information, or the lead is immediately disqualified with clear documentation of why.

Step 2: Insurance Verification

The Goal: Determine whether the patient’s insurance will cover treatment and quantify out-of-pocket costs upfront.

What gets verified:

Basic Eligibility:

  • Is TMS/Spravato/treatment covered by this insurance plan?
  • Is there a required prior authorization?
  • Are there any plan-specific restrictions or exclusions?

Coverage Requirements Met:

  • Has the patient failed the required number of antidepressants (usually 2–4)?
  • Are they currently on an oral antidepressant? (Some plans require this)
  • Is their diagnosis eligible for coverage? (Some plans only cover “treatment-resistant depression,” not first-episode depression)
  • Is concurrent therapy required? Is the patient engaged in therapy?

Financial Details:

  • Deductible: How much? How much is remaining?
  • Coinsurance: What percentage does the patient pay?
  • Out-of-network percentage: If applicable
  • Any session maximums or treatment limits?
  • Prior authorization requirement: Yes/No? If yes, what’s the timeline?

Outcome possibilities:

Fully eligible & covered: Insurance covers treatment. Patient’s out-of-pocket cost is clear. Prior authorization timeline documented.

Clinically eligible but financially restrictive: Patient qualifies clinically, but high deductible/coinsurance makes cost prohibitive. Might require payment plan discussion or recommendation to defer until deductible resets.

Clinically eligible but insurance denies: Insurance approval process has failed. May require appeal, additional documentation, or alternative treatment plan.

Insurance requires prior authorization: Timeline established. Documentation needed from clinic.

Not eligible: Clear reason documented (didn’t fail enough antidepressants, plan doesn’t cover, diagnosis ineligible, etc.). Patient and insurance requirements clearly communicated to patient.

The difference from unstructured approach: Coordinator says, “Yeah, we take your insurance.” Patient assumes coverage is confirmed. Patient starts treatment. Insurance denies. Bill arrives. Patient angry.

With structured verification: “Your insurance covers TMS, but you need prior authorization. We’ll submit documentation this week and hear back in 7–10 days. Your estimated out-of-pocket will be approximately $2,400 based on your deductible. Before we schedule, let’s confirm that cost works for you.”

Result: Clear insurance picture. Patient knows exactly what they’ll owe. No surprises. Leads that are financially unviable (e.g., uninsured with no ability to pay cash) are identified early, saving psychiatrist time.

Step 3: Clinical Criteria Assessment

The Goal: Determine whether the patient medically and psychiatrically meets criteria for the recommended treatment.

What gets assessed:

For TMS, typical criteria:

Diagnosis requirement:

  • Confirmed diagnosis of major depressive disorder (MDD) or treatment-resistant depression (TRD)
  • Moderate to severe symptoms (not mild)
  • Symptoms for at least 2 weeks (typically much longer)

Treatment failure requirement:

  • Failed at least 2 different antidepressants at adequate doses for adequate duration
  • Failed evidence-based psychotherapy, OR unable to tolerate medication side effects

Age:

  • Typically 18–70 (some centers extend beyond)

Contraindications ruled out:

  • No active, uncontrolled bipolar disorder or psychotic disorder (usually)
  • No implanted medical devices (pacemakers, cochlear implants, etc.)
  • No non-removable metal in/around head
  • No uncontrolled seizure disorder
  • No recent stroke or severe head trauma
  • Not pregnant/nursing (varies by protocol)

Psychiatric considerations:

  • Suicide risk assessment (active vs. passive ideation, intent, plan)
  • Substance abuse status (active use might disqualify)
  • Realistic expectations about treatment (patient understands protocol, timeline, limitations)

Similar criteria exist for Spravato and ketamine, with variations.

The clinical decision tree:

All criteria met, no contraindications: QUALIFIED. Proceed to Step 4.

Meets criteria but some contraindications: May require additional evaluation or specialist clearance. (Example: Patient has pacemaker but it’s MRI-compatible; may still be eligible with cardiology clearance.)

Doesn’t meet medication trial requirement yet: NOT QUALIFIED for TMS currently. Recommendation: Complete additional antidepressant trial, then reapply in 4–6 weeks. Add to follow-up schedule.

Failed criteria for psychiatric reasons (e.g., active psychosis, severe suicidal ideation): ROUTE TO EMERGENCY. Not appropriate for outpatient TMS. Recommend crisis resources or hospitalization.

Realistic expectations not evident: Patient thinks TMS cures depression in 1 session, or expects 100% symptom resolution. CONDITIONAL QUALIFICATION: Requires education and realistic expectation-setting before proceeding.

The difference from unstructured approach: Psychiatrist meets patient in consultation and discovers they don’t qualify. Appointment wasted. Patient disappointed.

With structured assessment: Lead doesn’t reach psychiatrist until clinical criteria are confirmed.

Result: Clear clinical qualification. Psychiatrist’s time is protected. Leads that need follow-up or emergency routing are identified early.

Step 4: Appointment Readiness Confirmed

The Goal: Ensure the patient understands the commitment required and is genuinely ready to start treatment.

What gets assessed:

Timeline Expectations:

  • How soon does the patient want to start? (Immediately? Next month? Just exploring?)
  • Do they understand the acute phase timeline? (TMS: 4–6 weeks, 5 days per week; Spravato: 8 weeks, 2–4x per week)
  • Do they have flexibility in their schedule? (If working 9–5, can they do 30-minute appointments at 10 AM?)
  • Do they understand maintenance phase? (Ongoing sessions for months after acute phase)

Financial Commitment Confirmed:

  • Patient has reviewed the estimated out-of-pocket cost
  • Patient has confirmed this cost is manageable (not just said “yes” to avoid awkwardness)
  • If significant cost, is patient open to payment plan?
  • Does patient understand their responsibility if insurance denies mid-treatment?

Motivation & Engagement Assessment:

  • Why is the patient seeking treatment NOW? (Acute crisis vs. chronic dissatisfaction vs. passive interest)
  • Have they tried other treatments? (If they’ve tried 1 therapy and dismissed it, motivation is low; if they’ve tried multiple and persisted, motivation is high)
  • Do they have social support for treatment? (Family support increases completion rates; social isolation decreases)
  • What are their realistic expectations about outcomes? (Understand TMS isn’t immediate, isn’t 100% effective, requires commitment)
  • Any red flags for no-show likelihood? (History of missed appointments? Current chaos/crisis in life? Unrealistic expectations?)

Logistical Confirmation:

  • Do they have reliable transportation? (Required for TMS appointments)
  • Can they arrange time off work or family responsibilities? (Easier for some life situations than others)
  • Do they have a way to check in if they have questions? (Understanding communication channels reduces anxiety)

Outcome possibilities:

Fully ready to proceed: APPROVED FOR SCHEDULING. Patient understands commitment. Realistic expectations set. High likelihood of completion.

Ready but needs payment plan: APPROVED WITH CONDITION. Arrange payment plan, then schedule.

Seems interested but not ready: CONDITIONAL APPROVAL. Recommend re-engagement in 2–4 weeks. Patient might be “just exploring” rather than genuinely committed. Better to follow up when readiness is higher than book them now and have no-show.

Significant barriers to completion: DISCUSS ALTERNATIVES. If patient has unstable housing, active substance abuse, untreated psychosis—TMS might not be the right fit right now. Consider alternatives or delay until stability improves.

Red flags for no-show: Document clearly. Consider requiring confirmation calls 24–48 hours before appointment. Consider requiring upfront payment or deposit.

The difference from unstructured approach: Coordinator books appointment. Patient has competing obligations, unrealistic expectations about cost or timeline, or discovers they’re not actually ready to commit. Patient no-shows or cancels. Appointment slot wasted.

With structured readiness assessment: Appointment confirmation is a high-confidence prediction of patient attendance and completion likelihood.

Result: Scheduled appointments with high show-up rates. Reduced cancellations and no-shows. Higher treatment completion rates.

Step 5: Coordinator Handoff

The Goal: Transfer the lead from the screening process to the clinic’s scheduling/administrative workflow with all necessary information organized and documented.

What gets handed off:

Complete Patient Profile Summary:

  • All intake information collected in Step 1
  • Insurance verification results and prior auth status from Step 2
  • Clinical criteria assessment and any special considerations from Step 3
  • Appointment readiness assessment from Step 4

Structured Documentation in CRM:

  • Lead status: “PRE-QUALIFIED” (vs. disqualified or pending additional info)
  • Clinical clearance: ✓ Yes/No
  • Insurance clearance: ✓ Yes/No/Pending PA
  • Financial status: Out-of-pocket estimate, payment plan if needed
  • Scheduling priority: High (ready to book immediately), Medium (ready but willing to wait), Low (interested but not urgent)
  • Any special notes or follow-up required

Clear Next Steps for Coordinator:

  • If scheduling: “Call patient to schedule first available slot. Confirm transportation and any logistics questions.”
  • If conditional: “Follow up in 2 weeks to confirm readiness. Insurance PA pending—contact insurance on [date] for status.”
  • If pending info: “Request [missing documentation]. Send secure message to patient. Follow up if no response within 3 days.”

Patient Communications Package:

  • Confirmation message with appointment details (or next steps if not yet scheduled)
  • Pre-appointment information packet (what to bring, what to expect, FAQ)
  • Cost estimates and insurance information
  • Any consent forms or documentation needed before first appointment

For Psychiatrist:

  • Brief clinical summary highlighting key decision factors
  • Any contraindications or special considerations
  • Patient’s stated goals and expectations
  • Any red flags or concerns noted during screening

The difference from unstructured approach: Coordinator receives a lead and has to make individual judgment calls about whether to book. Different coordinators make different decisions. Some patients who should be booked aren’t. Some who shouldn’t be booked are.

With structured handoff: Coordinator receives a PRE-QUALIFIED lead with complete information. Their only job is logistical execution (confirming appointment, sending reminders), not clinical judgment.

Result: Consistent decision-making. Higher-quality leads reaching psychiatrist. Reduced administrative confusion. Clearer communication with patients.

The Complete 5-Step Flow: Example Walk-Through

Let’s trace a lead through the entire structured process:

Lead enters: Patient fills out web form Friday evening asking about TMS. Lead routed to screening system.

Step 1 – Intake Information: Automated intake form or screening call (AI or human coordinator) captures comprehensive information. Patient reports 10-year depression history, recently tried Zoloft (6 weeks, inadequate dose) and Lexapro (8 weeks, adequate dose). Currently on no medications. No metal implants. No suicidal ideation. Employed, wants to feel better “to get back to normal.”

Result: Complete intake profile in CRM. Ready for Step 2.

Step 2 – Insurance Verification: System checks insurance (patient reports Aetna PPO). Real-time verification shows:

  • TMS covered: Yes
  • Prior auth required: Yes
  • Patient met med trial requirement: Not quite (only tried 2 SSRIs from same class; most insurers want 2–3 from different classes, OR 2 plus psychotherapy plus inadequate response)
  • Insurance likely WILL cover after one more trial OR additional documentation of inadequate response

Result: Eligible but pending. Coordinator contacts insurance to clarify. Turns out documentation of “inadequate response” can be provided by psychiatrist, so patient can proceed. Prior auth will be submitted after intake. Estimated out-of-pocket: $2,400 (assuming deductible already met).

Step 3 – Clinical Criteria Assessment: Patient meets clinical diagnosis requirement (MDD), failed adequate trial of one SSRI (Lexapro), currently on no meds (so no concurrent antidepressant—insurance might require this). No contraindications. Not in crisis.

Result: Clinically QUALIFIED with condition: Will require psychiatrist to start concurrent antidepressant before/during TMS, per insurance requirement. Documented.

Step 4 – Appointment Readiness: Coordinator calls patient to confirm readiness. Patient confirms:

  • Wants to start TMS ASAP
  • Has flexible work schedule (can do morning appointments)
  • Understands 4–6 week commitment
  • Confirms $2,400 out-of-pocket is acceptable
  • Has transportation arranged
  • Motivated by desire to feel “normal” again

Result: FULLY READY TO SCHEDULE. No barriers identified.

Step 5 – Coordinator Handoff: Coordinator books patient for psychiatric intake Tuesday at 10 AM. Sends confirmation SMS and email with pre-appointment packet. Notes in CRM: “Prior auth pending—submit after Tuesday intake once psychiatrist has all info.”

Psychiatrist sees patient Tuesday: Has complete pre-qual information. Knows patient clinically qualifies, insurance is likely to cover, patient is motivated, and understands timeline. Can focus intake on clinical depth rather than screening. Confirms diagnosis, discusses concurrent antidepressant, explains TMS protocol, submits prior auth documentation.

By Wednesday: Prior auth submitted. By Friday: Insurance approves. TMS treatment begins Monday.

Timeline: Lead entered Friday. Treatment began the following Monday. 7 days from inquiry to first treatment.

Compare to unstructured approach: Lead would receive Monday call saying “You might qualify, let me schedule a consultation.” Consultation might be 2 weeks out. During intake, psychiatrist discovers insurance requirement wasn’t understood, prior auth wasn’t ready, patient’s med history is unclear. Delays follow. First treatment might begin 4+ weeks after initial inquiry.

Why Structure Matters More Than You Think

A structured 5-step process might seem bureaucratic. But it actually removes bureaucracy by eliminating rework.

Unstructured approach:

  • Lead books consultation → Psychiatrist discovers they don’t clinically qualify → Wasted appointment → Patient disappointed → Maybe follow-up in future
  • Lead books consultation → Insurance denies during treatment → Financial disputes → Patient angry → Likely patient loss
  • Lead books consultation → Patient doesn’t show up → Coordinator calls back → Pattern of flakes → Wasted time

Structured approach:

  • Lead vetted comprehensively before reaching psychiatrist → Psychiatrist only sees truly qualified patients → High-quality consultations → High booking-to-treatment conversion
  • Insurance verified upfront → No surprise denials → No financial disputes → Smooth patient journey
  • Readiness confirmed upfront → High show-up rates → Reduced cancellations → Efficient scheduling

Result of structure: Better patient experience, higher conversion rates, less administrative chaos, better use of psychiatrist time.

Building Your 5-Step Process

Implementation checklist for your clinic:

Step 1 – Intake Information:

  •  Create standardized intake form (digital or paper) capturing all required fields
  •  Train coordinators on comprehensive questioning (don’t skip sections)
  •  Create clear “red flag” criteria that trigger immediate referral to psychiatrist or emergency resources
  •  Integrate form into your CRM so data is automatically captured

Step 2 – Insurance Verification:

  •  Create verification checklist specific to your top 20 insurance companies
  •  Train coordinators on real-time eligibility verification (phone, system portal, etc.)
  •  Document all findings in CRM (deductible, coinsurance, prior auth status, coverage decision)
  •  Calculate and communicate estimated out-of-pocket costs to patient

Step 3 – Clinical Criteria Assessment:

  •  Document specific clinical criteria for each treatment you offer (TMS, Spravato, ketamine)
  •  Create decision tree (meets criteria / meets with conditions / doesn’t meet)
  •  Train coordinators or assign to clinical staff (depends on scope)
  •  Document clinical decision in CRM with clear reasoning

Step 4 – Appointment Readiness:

  •  Create readiness assessment questionnaire (timeline, cost, motivation, logistics)
  •  Coach coordinators on assessing genuine commitment vs. passive interest
  •  Document readiness level in CRM
  •  Identify any barriers and document mitigation plan (payment plan, follow-up timing, etc.)

Step 5 – Coordinator Handoff:

  •  Create standardized handoff template for CRM
  •  Define clear status designations (“PRE-QUALIFIED,” “PENDING,” “DISQUALIFIED”)
  •  Create clear next-step workflows for scheduling vs. follow-up vs. alternative routing
  •  Train coordinators on their specific responsibilities for each lead status

Automation opportunities:

  • Use AI screening system to automate Steps 1–2 (intake + insurance verification)
  • Use rules-based workflows in your CRM to auto-route based on criteria assessment
  • Use automated confirmation calls/texts at Step 4 to confirm readiness
  • Integrate handoff trigger to alert scheduling coordinator automatically

The Bottom Line

Marketing leads aren’t the problem. Your conversion rate isn’t a marketing problem. It’s a qualification problem.

Implement a structured 5-step screening process and three things happen:

  1. Higher conversion rates: Only truly qualified leads reach your psychiatrist, and those leads have been vetted comprehensively. Psychiatrist consultations are high-confidence sales conversations, not screening calls.
  2. Lower no-show rates: Appointment readiness is confirmed before scheduling, so patients who book are actually ready to show up and commit.
  3. Fewer insurance disputes: Insurance is verified upfront, prior auth is handled systematically, costs are clear, and surprises are eliminated.

The result: More patients starting treatment, shorter time from inquiry to first appointment, fewer cancellations and complications, and significantly higher lifetime patient value.

That’s what turns a 12% conversion rate into a 40%+ conversion rate.

That’s what separates clinics that struggle with lead conversion from clinics that convert leads into thriving patient relationships.