Insured patients, uninsured admin
A patient phones to book and mentions they are covered through their employer's health insurance. Reception writes the membership number and an authorisation code on a sticky note, or in a free-text field. The patient comes in for several visits. Somewhere around visit five, someone realises the authorisation was for fewer visits than that, or has expired, or excluded the initial consultation.
Invoices go to the insurer. Some are paid in full, some partly, some rejected for a missing detail. Payments arrive in a bulk remittance that lists claim numbers, not your invoice numbers. At month end, a person sits with the bank statement and a spreadsheet trying to work out who still owes what.
Why insured work is so fiddly
Each insurer has its own rules about what is covered, how many sessions an authorisation allows, whether a GP referral is needed, how invoices must be submitted and what the patient pays directly. Your clinic software can usually record that an appointment is 'insured', but it rarely tracks the authorisation as a thing with a limit and an end date.
So the tracking happens in people's heads, and the gaps show up as unpaid invoices months later, often too late to fix without an awkward conversation with the patient.
Where the money goes missing
| Leak | Why it happens | What the tracker does |
|---|---|---|
| Visits beyond the authorised number | Nobody counting | Warns reception before the visit is booked |
| Expired authorisation | Date not recorded properly | Flags at booking and a week before expiry |
| Missing details on invoice | Invoice built by hand | Checks required fields per insurer before sending |
| Shortfall not billed to patient | Remittance not matched | Matches payments and raises the balance |
| Rejected claim never resubmitted | Rejection letter filed away | Keeps it open on a list until resolved |
How we put it right
- At booking, reception completes a short insurance panel: insurer, membership number, authorisation reference, sessions authorised, start and end dates and any excess.
- Each attended visit counts against the authorisation, and the remaining balance is shown whenever the patient is booked.
- Invoices to insurers are produced with each insurer's required fields filled in and checked, then submitted in the way that insurer accepts.
- Remittances, whether emailed PDFs or bank lines, are read and matched to open claims; unmatched lines go to a person with suggested matches.
- Shortfalls and excesses create a patient invoice automatically, with a clear explanation of why.
- An open-claims list shows every unpaid insurer invoice by age, so chasing happens weekly rather than at year end.
- Paid items post to Xero or your accounts package with the insurer as the customer.
Insurer portals and rules change, so we build the per-insurer rules as settings your team can update, not as code only a developer can touch. We do not tell you which insurers to work with or how to price your treatment; those are business decisions.
Life after the tracker
Self-funding patients are not forgotten either. When an authorisation runs out mid-course, the tracker prompts reception to ask whether the patient wants to continue privately, before the next visit rather than after it, so nobody is surprised by an invoice. How you word that conversation is up to you; the point is that it happens at the right time.
Reception knows before booking whether an insured patient has sessions left. Invoices go out complete. Payments are matched in minutes rather than an afternoon. Shortfalls reach patients promptly, while the visit is still fresh in their mind, which makes them far easier to collect. The owner can see, on any day, exactly how much is owed by each insurer.
Is insured work causing this for you?
- Authorisation codes are written in free text or on paper.
- Patients have been treated beyond their authorised sessions without anyone noticing.
- Remittances are matched by hand with a spreadsheet.
- You are not sure how much is outstanding from insurers right now.
- Shortfalls are sometimes discovered months after the visit.