Persistence Without Panic: How to Follow Up Without Feeling Pushy

There is a distinct and familiar emotional pattern that follows the act of asking for something: a rush of adrenaline during the send, then a long, quiet dip while waiting for a response. When psychologists request a rate increase or initiate a contract renegotiation with an insurance company, the high-stakes ask is often followed by an emotional crash—something between dread, doubt, and fatigue. The silence on the other end begins to throb. Days pass. And the question quietly arises: Do I follow up? Or do I just… let it go?

For many clinicians, the answer feels charged. Following up stirs anxiety—not about the content, but about how one will be perceived. There is a reflexive fear of seeming pushy, aggressive, difficult. The very idea of persistence begins to feel morally suspect.

So they hesitate. They wait longer than they should. They talk themselves into giving the system more time, even if it’s already been more time than it should have taken. They back away—not because the request was invalid, but because the silence was uncomfortable.

This is where self-advocacy, even when technically begun, begins to unravel. Not in the drafting, not in the request itself—but in the follow-through.

And it’s precisely here that psychologists need a new framework: one that separates persistence from panic, professionalism from passivity, and self-respect from perceived confrontation.

The Fantasy of the Single Ask

Most psychologists don’t like repeating themselves. They are trained to be precise, thoughtful, and clear. Their interventions are calibrated. Their insights are timed. In clinical work, saying something once—at the right moment, in the right way—can change everything.

But administrative systems are not like therapy.

No one in provider relations is waiting to be moved. No one is taking notes on nuance. No one is reading between the lines. If your request is seen at all, it is likely seen quickly, briefly, and filed away. The idea that one clear, well-crafted message is sufficient is a fantasy rooted in the clinician’s own standards—not in institutional reality.

Systems respond not to elegance but to repetition. Persistence is not rudeness. It is the minimum threshold for visibility.

Why Therapists Hate the Follow-Up

The follow-up email is where many clinicians freeze. Not because they lack the words, but because it feels like crossing a line—an invisible one, woven from internalized fears about being too much. Most therapists are trained to dial themselves down: to be non-intrusive, to track others’ needs, to prioritize relational ease. Following up feels like the opposite. It can stir fears of rejection, fears of being labeled, fears of not being taken seriously—or worse, being taken seriously and resented for it.

And so, many therapists delay. Or worse, they interpret the delay in response as a message: They didn’t answer, so they must have decided. The silence means no.

But in most cases, the silence doesn’t mean no.

It means nothing.

It means the system is slow, or chaotic, or distracted. It means your request is one of many. It means your follow-up is not rude—it’s necessary.

And it is your right to be remembered.

Persistence Is Not Pressure

Let’s clarify something: you are not begging. You are not escalating. You are not making demands. You are following up on a professional inquiry that has received no response.

If the roles were reversed—if a client didn’t show up for an appointment or failed to return a required form—you would follow up without shame. You would send a reminder. You would name the timeline. You would assume they forgot, not that they were rejecting you.

This is the same.

To follow up on a rate review is not to become overbearing. It is to hold the system accountable to a reasonable communication standard. The content of your request doesn’t become less legitimate just because it’s uncomfortable to revisit.

In fact, consistency often increases legitimacy. A provider who follows up at steady intervals, without reactivity, without aggression, is more likely to be taken seriously—not less.

The Emotional Energy of Waiting

One of the hardest parts of persistence is the psychological toll of suspended expectation. The in-between state—after the ask, before the answer—is depleting. It quietly siphons mental bandwidth. You find yourself checking your inbox more often. Wondering if the silence is meaningful. Rereading what you wrote. Imagining the worst.

This is natural.

But it’s also optional.

You do not need to stay in that suspended state. The moment you decide on a follow-up schedule—on timing, language, and tone—you free yourself from the drift of waiting. You place the uncertainty into a structure.

Structure reduces anxiety. It converts rumination into motion.

You don’t need to follow up today. But you do need to know when you will.

A Script Is Not a Demand

For those who freeze at the thought of “being pushy,” let’s reframe the tone. A follow-up doesn’t need to be an argument. It can be brief, clear, and kind. It might sound like:

“Hi [Name],
I wanted to follow up on my rate review request sent on [date]. Please let me know if additional information would be helpful. I look forward to hearing back and appreciate your time.”

That’s it.

You don’t need to re-argue your case. You don’t need to add more rationale. You don’t need to escalate—unless you’ve followed up multiple times with no response.

Persistence is not about increasing volume. It’s about maintaining presence.

What to Expect (and What Not To)

Most provider reps will not respond to the first message. Some will not respond to the second. Many will only respond after a third message, or a phone call. This is not because your request was offensive or inappropriate. It’s because response is not automatic. It must be prompted.

That’s not your fault.

And it’s not a reason to stop.

Keep your tone steady. Keep your intervals professional—perhaps 10 to 14 days apart. Note each follow-up in a tracking log. And remember: your job is not to make them say yes. Your job is to remain present until they say something.

Ethical Consistency, Not Aggression

Persistence, when done ethically, is a form of professionalism. It says: I am invested in this request. I am willing to hold the thread. I am committed to the process.

It also says: I respect myself enough not to abandon a valid ask just because the system is slow or unresponsive.

There is a difference between insisting and holding steady. One demands. The other waits and returns, waits and returns, waits and returns—until clarity is achieved.

And clarity, not compliance, is the goal.

When to Let Go

There may come a point when you’ve followed up multiple times with no meaningful response. At that point, you may decide to escalate—to a supervisor, to a formal provider dispute, or to a professional association. Or you may decide to disengage, to drop the request, or to reassess your participation with the payer entirely.

But that decision should come from clarity—not exhaustion.

Letting go after persistence is informed. Letting go before persistence is resignation.

And resignation has no place in sustainable clinical practice.

The Long Arc of Professional Voice

Most therapists will not learn to follow up gracefully on their first try. It will feel awkward. Maybe even shameful. But every time you do it, you deconstruct a little more of the training that taught you to avoid tension at all costs. You widen your tolerance for being seen as firm. You loosen the grip of the belief that self-respect equals selfishness.

Eventually, follow-up becomes just another part of the job—like charting, like scheduling, like billing. But until then, it’s an edge.

A meaningful one.

And like most edges in therapy, it’s where the work happens. Not just with clients.

With yourself.

About the Editor
Cody Thomas Rounds is a Clinical Psychologist-Master based in Burlington, Vermont, specializing in psychological assessment and collaborative care. He serves as Editor-in-Chief of PsycheAtWork Magazine, founder of the Learn.Do.Grow educational platform and the PsycheAtWork YouTube channel. In addition to publishing, he offers consultation and supervision for psychologists and creates practical therapist resources designed to support ethical, sustainable practice.