Session seven, and the insurer only approved five
An insured patient comes to your clinic with a knee injury. They rang their insurer beforehand and have an authorisation code for an initial assessment and a set number of follow-up sessions. Reception note the code in the patient record. The physio plans a course of treatment. The patient keeps booking.
Months later, the claim for the sixth and seventh sessions is rejected. Nobody noticed the limit had been reached, the physio did not request more sessions, and the patient did not know. Now you are either writing off the sessions or sending an invoice to a patient who believed they were covered.
Why the count never gets done
Authorisations arrive by email, by phone or through insurer portals, each insurer with its own format. The number of sessions approved, the expiry date and any conditions are written into a note or a custom field, if they are recorded at all. Your clinic system, whether Cliniko, TM3 or another, does not naturally compare that number with the appointments attended.
The physio is focused on treatment and may not know how many sessions are left. Reception see bookings, not authorisations. And when the insurer does allow further sessions, the request usually needs a progress update from the physio, which takes time and is easy to put off until the limit has already passed.
What exceeding authorisations costs
| Missed step | Consequence |
|---|---|
| Limit not tracked | Sessions delivered that the insurer will not pay |
| Extension not requested | Treatment paused or continued at the clinic's risk |
| Expiry date missed | Sessions after the date rejected |
| Patient not told | Surprise invoice and a complaint |
| Rejections found late | Months of admin untangling claims |
The physio's clinical plan should not be driven by the paperwork, but the paperwork needs to keep up with the plan, so the patient and the clinic know where they stand before each session.
There is a quieter cost too. When physios are regularly caught out by limits, they start asking patients about their cover during treatment time, which is neither a good use of the session nor a conversation most physios enjoy.
How we count sessions against authorisations
- Each authorisation is recorded as its own item: insurer, code, sessions approved, expiry date and any conditions. Emailed authorisations can be read and pre-filled for reception to confirm.
- Attended sessions from your clinic system are counted against the active authorisation automatically.
- When one covered session remains, or the expiry date is close, the physio and reception are alerted.
- The physio gets a prompt to request further sessions if they intend to continue, with a progress report template ready to complete in their own words.
- If no extension is in place, the next booking shows a clear warning, and the patient is asked to confirm self-pay terms before attending.
- A weekly list shows every insured patient near or over their limit, by insurer.
Whether to continue treatment is the physio's decision with the patient. The system makes sure that decision is taken knowing what is covered.
What the clinic sees afterwards
Reception know, for every insured patient, how many covered sessions remain. Physios request extensions before the limit rather than after. Patients are told in advance if they are moving to self-pay. Claims go in against valid authorisations, and rejections for over-treatment become rare exceptions you can explain.
The owner also gets a picture of how each insurer behaves: how many sessions they typically authorise and how often extensions are granted, which helps when deciding which insurers to work with.
Is this happening in your clinic?
- Authorisation limits are written in notes, not tracked
- Claims come back rejected for sessions beyond the limit
- Physios are unsure how many covered sessions a patient has left
- Extension requests are made after the limit has passed
- Patients are surprised by invoices for sessions they thought were covered