A good course of treatment, and a refused claim
An insured patient books with your clinic for shoulder pain. They have an authorisation number from their insurer and a physio treats them over several sessions. When the claim goes in, the insurer asks for the GP referral letter that the policy requires before physiotherapy is covered. The patient never had one. They self-referred, assuming their insurance allowed it.
Now the patient has to ask their GP for a retrospective letter, which the GP may not be willing to write, or the clinic has to bill the patient for sessions they thought were covered. Either way, the clinic finds out at the worst possible moment.
Another patient did have a referral letter, and brought it to the first appointment. The physio read it, handed it back, and nobody kept a copy. When the insurer asks, it is sitting in a kitchen drawer across town.
Why the letter goes missing
Policies differ. Some allow patients to go straight to a physio, some need a GP or specialist referral first, and the rules can depend on the scheme the employer bought. Patients rarely know which applies to them, and insurers' authorisation calls do not always make the requirement clear.
At the clinic, the booking process asks for an authorisation number but not whether a referral letter is needed or on file. Letters that do exist arrive on paper, as photos, or attached to emails, and are not always saved against the patient in your clinic system.
The physio, understandably, is focused on the patient in front of them. Checking policy paperwork is not their job and should not have to be.
What missing referrals cost
| Gap | Consequence |
|---|---|
| Requirement not asked about | Treatment given without a required referral |
| Letter seen but not saved | Cannot provide it when the insurer asks |
| Retrospective letter requested | Awkward for the patient and their GP |
| Claim refused | Sessions written off or billed to the patient |
| Pattern unnoticed | Same insurer's schemes cause the same refusals |
The awkwardness with the patient's GP is easy to overlook. Asking a busy NHS surgery for a letter after treatment has finished is not a good way to build a referral relationship.
How we put the check before the first session
- The booking step for insured patients asks, in plain words, whether their insurer has told them they need a GP or specialist referral, and records the answer alongside the authorisation.
- Where you know an insurer or scheme usually requires a referral, the booking step says so and asks the patient to check, using wording you approve.
- If a referral is needed, the patient receives a secure upload link for the letter, with reminders before the first appointment.
- Letters that arrive by email or on paper are saved against the patient and the authorisation, so they can be found when the claim is made.
- Until the letter is on file, the booking shows insured status as pending, and the patient is asked to agree self-pay terms as a fallback if you choose.
- Claims are only prepared once the paperwork the policy needs is present, and a monthly report shows refusals by insurer and reason.
What a policy requires is the insurer's decision, and the patient's own responsibility to check. The system asks the right questions early and keeps the evidence in one place.
What the clinic gains
Patients find out before treatment starts whether they need a referral, when getting one is straightforward. Letters are saved where the billing team can find them. Claims go in complete. Refusals for missing referrals become rare, and the ones that remain have a clear record of what the patient was asked and told.
Reception gain confidence too. They no longer have to guess at each insurer's rules on the phone, because the booking step asks the questions and records the answers the same way every time.
Could this be happening to you?
- Claims have been refused because a referral letter was missing
- Booking does not ask whether a referral is required
- Referral letters are seen at the first session but not saved
- Patients assume their insurance allows direct access
- You have asked GPs for letters after treatment has ended