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An unreturned inquiry costs a practice twice: the marketing money spent to generate it, and the expected revenue from a client who never books. Cost per inquiry is monthly marketing spend divided by monthly inquiries. Lost value is expected sessions per new client, times average reimbursement per session, times the share of inquiries that normally become clients.
What is a new client worth to a behavioral health practice?
A new client is worth the revenue from every session that client attends. The working figure is expected sessions per new client multiplied by average reimbursement per session. A practice can pull both numbers from the past year of its own EHR or billing reports, split by payer where the mix varies.
Session rates vary widely by payer. A study published in Health Affairs Scholar in September 2024 found that cash pay rates “for a typical session averaged $143.26, compared to $82.77 in Medicaid,” based on psychotherapist directory listings collected in late 2023. The authors noted they did not have data on commercial prices.
That spread is the reason to use the practice’s own payer mix. A mostly Medicaid practice and a mostly self-pay practice will put very different values on the same lost inquiry, and commercial plan rates vary again.
Why is one inquiry worth less than one full client?
One inquiry is worth less than one full client because not every inquiry books and not every new client stays. The expected value of an inquiry is a client’s revenue multiplied by the share of inquiries that normally become clients. For example, a practice that converts 40 percent of its inquiries should count 40 percent of a client per inquiry.
Sessions per client also shift over time. Describing national psychotherapy trends from 2018 to 2021, Mark Olfson, MD, MPH, a professor of epidemiology and psychiatry at Columbia University Mailman School of Public Health, said, “A decrease in the fraction of patients with just one or two psychotherapy visits further suggests there was a decline in early drop-out.”
For a single practice, early drop-out and no-shows shrink the expected session count. Using the practice’s own average, including clients who came only once, keeps the estimate honest.
What does the full calculation look like?
The full calculation puts two numbers side by side: the marketing spend already sunk into each inquiry and the expected revenue that inquiry carried. The table below is an illustrative example with round numbers chosen to show the method. The figures are not benchmarks and do not describe any real practice.
| Step (illustrative example) | Math | Result |
|---|---|---|
| Cost per inquiry | $6,000 spend / 80 inquiries | $75 |
| Revenue from one new client | 10 sessions x $100 | $1,000 |
| Expected value per inquiry | $1,000 x 40% | $400 |
| Cost of 10 unreturned inquiries | 10 x ($75 + $400) | $4,750 a month |
At that pace the example practice loses $57,000 a year in wasted spend and expected revenue. Unreturned leads do happen: a Beacon audit of a client’s inquiries found leads that were never returned. Why the first response carries so much of the budget is covered in The First Phone Call Is Your Whole Marketing Budget.
What does this answer not cover?
This answer covers a revenue-based way to estimate what an unreturned inquiry costs a practice. It does not measure profit. Clinician pay, overhead and billing costs come out of every session, so owners who want a margin view should apply their own margin to the expected value.
It leaves out referral value, returning clients and the human cost to a person who reached out and heard nothing. It is also not accounting, tax or valuation advice, and owners should review these numbers with their accountant before using them in financial planning.
The dollar figures in the example are round numbers chosen to show the method. The only published figures here are the session rates from the cited study, which reflect late 2023 directory listings and may differ from what a given practice is actually paid.
Frequently asked questions
What if a practice doesn’t know its conversion rate?
A practice that doesn’t know its conversion rate can estimate it from one recent month: count every inquiry, then count how many of those people attended a first session. The rough share is enough to start the calculation, and repeating the count each month makes the estimate more reliable.
Should cost per inquiry be calculated by channel?
Cost per inquiry can be calculated by channel by dividing each channel’s spend by the inquiries that channel produced. Paid search, directory listings and referral programs can cost very different amounts per inquiry, and running the numbers separately shows which unreturned inquiries were the most expensive to lose.
The owner-level case for treating these losses as money on the books is in The Lead You Never Called Back Is Still on Your Balance Sheet.
