Established practice
When did you last negotiate with your insurers?
Insurer rates and terms affect every insured patient you see. Here is how to prepare for a better conversation.
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- steps
- 8
- steps
- to start
- Half a day to 2 days
- to start
- scorecard
- Free
- scorecard
The short answer
Many clinic insurer agreements roll over unchanged because nobody owns them and nobody prepares evidence, while tariffs stay flat, codes go out of date and payments slip. Pull every insurer, NHS and corporate contract into one register, measure what each actually pays and how fast, chase short payments, and build an evidence pack and a clear ask. Then open the conversation four to six months before renewal. Insurers do not always move on price, but they may move on codes, packages, payment terms and network status.
What good looks like
Where you stand, before and after
Insurer contracts
- Contract register · renewal reminders
- Evidence pack ready · negotiation planned
Illustrative sample, not a real person or result.
8 steps
Do it yourself: step by step
0 of 8 done
List every insurer agreement (Bupa, AXA Health, Aviva, Vitality, WPA and any others you bill, such as international insurers or healthcare trust administrators) and every NHS, corporate or trust scheme contract, with rate schedule and tariff basis, effective date, renewal date, notice period, last uplift date, uplift clause, payment terms and named insurer relations contact
- Time
- Half a day to 2 days
- Typical cost
- £0
- Who does it
- Practice manager
Done when: Every payer has a row and every renewal and notice date is known
This problem is Solvable.
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Payer contract register, performance table and evidence pack
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Payer contract register
| Payer | Type (insurer / NHS / corporate) | Contract or schedule ref | Effective date | Renewal date | Notice period | Tariff basis | Last uplift date | Uplift clause | Payment terms | Owner | Next action and date |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Bupa | Insurer | [ref] | [date] | [date] | [x months] | [per episode / per code / package] | [date] | [none / CPI / fixed %] | [x days] | [name] | [action] |
| AXA Health | Insurer | ||||||||||
| Aviva | Insurer | ||||||||||
| Vitality | Insurer | ||||||||||
| WPA | Insurer | ||||||||||
| [Other insurer] | Insurer | ||||||||||
| [Healthcare trust administrator] | Trust | ||||||||||
| [NHS contract] | NHS | ||||||||||
| [Corporate or trust scheme] | Corporate |
Performance by payer, last 12 months
| Payer | Episodes | Income | Average income per episode | Direct cost per episode | Margin % | Average days to payment | Rejection or short-payment rate |
|---|---|---|---|---|---|---|---|
| [Payer] | [ ] | £[ ] | £[ ] | £[ ] | [ ]% | [ ] | [ ]% |
Evidence pack checklist (one per payer)
- Activity: patients and episodes for this payer, last 24 months, by quarter
- Income: gross income by procedure code, last 24 months
- Margin: your cost per procedure against this payer's tariff for your top 10 procedures
- Payment: average days to payment, rejected claims and short payments
- Access: average days from referral to first appointment and to treatment
- Quality: patient satisfaction, return or complication rates you record, CQC rating
- Costs: increases since the last uplift (staff, rent, consumables)
- What you offer: capacity, guaranteed access times, set-price pathways, new services
- The ask: two or three specific changes with a figure against each
- Fallback and walk-away: what you will accept, and the point at which you would not renew
Opening email
Subject: [Clinic name] contract review ahead of [renewal date]
Dear [name],
Our agreement with [payer] renews on [date]. Over the last two years we have treated [x] of your members across [specialties], with an average wait from referral to treatment of [x] days and patient satisfaction of [x]%.
Our costs for [procedures] have risen by [x]% over that period, and our current tariff no longer covers them for [x] procedures. I have attached a short summary.
I would like to meet in the next four weeks to discuss [ask 1], [ask 2] and how we can support [payer's priority, for example faster access in orthopaedics].
Kind regards, [Name, role, clinic]
Avoid these
Common mistakes
- Waiting for the insurer to offer an uplift, which may never happen.
- Missing the notice window and rolling over on the old rates for another year.
- Arguing on cost inflation alone, with no volume, access or quality evidence.
- Negotiating without knowing which procedures already lose money at the current tariff.
- Accepting short payments without querying them.
- Billing with out-of-date codes, so complex work is paid at a simpler rate.
- Letting one person hold all the payer knowledge so it leaves when they do.
Free personal check
Done by Paul Robinson, not software
Answer seven quick questions and I'll show you how ready you are to renegotiate with insurers
What I need from you
- Seven tap answers about your insurer agreements
- Your clinic name and town
What you get
- How prepared you are for each renewal
- The three pieces of evidence to build first
- When to open the conversation
Within 2 working days
No sign-in, no sales call. I read every request myself and reply on WhatsApp.
Free tools
Check where you stand
Benchmarks
69% of UK private admissions were insurance-funded in Q1 2026, and insured admissions fell 2.6% year on year
Insured work still dominates most clinics' income, so small tariff changes have a large effect
A 3% uplift on £600,000 of insured income is worth about £18,000 a year
Illustrates why an annual review is worth a few days of work
Solvable estimate
Paul Robinson
14 years in UK private healthcare
I solve this one for clinic and hospital teams
Want a hand? I'll look at your situation and tell you the three things I'd tackle first.
A few quick questions, about two minutes. I read every one myself and usually reply the same day.
No sales call unless you ask for one. Just a straight answer from me.
I reply personally, usually the same day.
Questions
Frequently asked questions
Will insurers really negotiate with a small clinic?
Sometimes on price, more often on terms. Small clinics tend to get further asking for specific codes, a package price or faster payment than a headline uplift. Data on volume, outcomes and cost makes any movement more likely.
When should we start?
Four to six months before renewal. Check the notice period in each contract first, because once it has passed you have little leverage.
What if the insurer says no?
Ask what evidence would change the answer, ask for something else such as code changes, faster payment or a new pathway, and get the reply in writing. Then decide against your walk-away terms and diarise the next cycle.
Should we drop a loss-making contract?
Only after checking whether it brings in referrals or capacity use you would otherwise lose. You can also limit capacity for that payer's lowest-margin work.
Can we compare rates with other local clinics?
No. Sharing price information with competitors can breach competition law. Benchmark from your own costs and published information only, and take advice from a competition lawyer if you are unsure. This is general information, not legal advice.
Do we need outside help?
Not to follow these steps. A healthcare solicitor should review any new contract terms before you sign.
Running a hospital rather than a clinic?
See: Insurer contract negotiations are not going your way
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