Established practice
You didn't become a practice manager to chase insurers.
Most insurer delays come from a few avoidable mistakes. Here is how to get paid faster with less chasing.
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- steps
- 7
- steps
- to start
- 5 to 10 minutes per patient
- to start
- scorecard
- Free
- scorecard
The short answer
Most rejected or slow insurer claims come from three things: no authorisation number, the wrong procedure code, or missing details. Check authorisation and cover before every appointment, use the correct CCSD procedure codes, bill electronically through Healthcode within days, and review unpaid claims weekly by age. Tell patients about any shortfall in writing before treatment.
What good looks like
Your numbers, before and after
Unpaid insurer invoices
Illustrative sample, not a real person or result.
7 steps
Do it yourself: step by step
0 of 7 done
At booking, take the insurer, membership number and authorisation code. Check what is covered (outpatient limit, excess, diagnostics) and record it in the patient record. Do not book treatment without a code
- Time
- 5 to 10 minutes per patient
- Typical cost
- Free
- Who does it
- Reception team
Why it matters
Missing or wrong authorisation is a common reason claims are rejected.
Done when: Every insured appointment in the diary has an authorisation code recorded
This problem is Solvable.
Copy this script
Pre-authorisation script and shortfall letter
Free to copy, adapt and use. No sign-up.
Booking script for insured patients
"Thank you. As you are using your insurance, I need a few details so the claim goes through smoothly.
- Which insurer are you with?
- Your membership or policy number, please.
- Have you called your insurer for an authorisation code for this appointment? If not, please call them on the number on your card, quote [consultant name] and the reason for referral, and ring us back with the code.
- Do you have an excess or an outpatient limit on your policy? We will bill your insurer, but anything not covered is your responsibility.
- I will email you confirmation with your appointment and what we have recorded."
Record: insurer | membership number | authorisation code | outpatient limit | excess | date checked | initials
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Shortfall letter
Dear [patient name],
Thank you for choosing [consultant name] for your [procedure].
Your insurer, [insurer], has authorised this treatment under code [code]. [Consultant name]'s fee for this procedure is £[fee]. Based on your insurer's published fee schedule, they are expected to pay £[insurer amount].
This means there is likely to be a shortfall of £[amount], which would be payable by you. [Any excess on your policy is separate.]
Please confirm that you are happy to go ahead on this basis by replying to this email or signing below. If you would like to discuss this, call me on [number].
Kind regards, [Name], on behalf of [consultant name]
I accept the possible shortfall described above. Signed: ______ Date: ______
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Weekly chase routine
| Age of claim | Action |
|---|---|
| 0 to 30 days | No action unless rejected |
| 31 to 60 days | Check status on portal or Healthcode, chase by email |
| 61 to 90 days | Phone the insurer, note reference, escalate |
| Over 90 days | Escalate in writing and review with consultant |
Avoid these
Common mistakes
- Booking the appointment before the patient has an authorisation code.
- Using last year's insurer fee schedule.
- Telling patients about a shortfall after treatment.
- Batching claims and submitting them weeks later.
- Chasing only when someone notices cash is short.
Free personal check
Done by Paul Robinson, not software
I'll check your insurer billing routine and show where claims are slowing down
What I need from you
- Number of insurers you bill
- Answers to eight tap questions
What you get
- Where your claims are getting stuck
- A weekly chasing routine
- Whether outsourcing would pay
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
Before the first consultation, and before further tests or treatment
Under Article 22 of the CMA Order, consultants must give written fee information when an outpatient appointment is confirmed, and an estimate for recommended tests or treatment within two working days of the final outpatient consultation, or before surgery if sooner. The Order does not mention shortfalls, but this estimate is the natural point to warn an insured patient of one
Source: CMA Private Healthcare Market Investigation Order 2014 (as amended)
3% to 8% of collections
Typical fee charged by UK private practice billing suppliers. billing suppliers usually charge a share of what they collect (Civica Medical Billing and Collection bases fees on amounts collected); exact rates are on request
Solvable estimate
Under 10%
Share of insured debt over 60 days in a well-run practice. a working target, not a published benchmark
Solvable estimate
Paul Robinson
14 years in UK private healthcare
I'll introduce you to someone who solves this for practice managers
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
Who is responsible for getting the authorisation code?
The patient, with their insurer. Your job is to make sure you have it before the appointment and to explain why.
What is a CCSD code?
The standard procedure codes UK private medical insurers use for billing, maintained by the CCSD Group, which includes Bupa, AXA Health, Aviva and Vitality. Use the code that matches what was done.
Can we charge a patient a shortfall?
Yes, if the consultant is not fee-assured with that insurer for that procedure and the patient agreed in writing before treatment. Consultants recognised by AXA PPP (now AXA Health) from July 2008, and by Bupa through the recognition process that opened in June 2010, must charge within that insurer's fee schedule, so they cannot charge above it. Check each insurer's rules.
How fast should insurers pay?
It varies by insurer and claim. Clean electronic claims are usually paid within weeks; anything over 30 days is worth checking.
Should we outsource billing?
If chasing takes more than a day a week, or debt over 60 days keeps growing, a billing supplier often pays for itself.
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