Session seven of six
An insured client comes for their seventh session. You realise afterwards the insurer only authorised six, and the request for more was never sent. Now you have a session nobody has agreed to pay for, and a conversation with a client that has nothing to do with their therapy.
Another insurer rejects an invoice because the authorisation code was from the first block, not the extension. A third pays late because the invoice went to the wrong address for that scheme. Each insurer has its own portal, form and way of doing things.
Why authorisations slip
The authorisation lives in an email or a portal. The session count lives in your diary. The invoice lives in your accounts. Nobody joins them up until something goes wrong.
- Each authorisation has a code, a number of sessions and often an expiry date.
- Extensions come with new codes that replace or add to the old one.
- Insurers differ on invoice format, submission route and what must be included.
- Clients sometimes have an excess or a shortfall they pay themselves.
- Associates see insured clients but the practice does the billing.
Where it hurts
| Slip | Consequence |
|---|---|
| Sessions beyond authorisation | Unfunded sessions and an uncomfortable conversation |
| Wrong code on invoice | Rejected claims and resubmission work |
| Expired authorisation missed | Sessions delivered after cover ended |
| Client share not collected | Excess or shortfall amounts forgotten |
| Slow billing | Insurer payments arriving much later than they could |
The unfunded session is the painful one. You can bill the client, write it off, or ask the insurer to backdate an extension, and none of those is a conversation you want to have with someone mid-way through therapy.
Resubmissions are the slow drain. Each rejected invoice means finding the right code, correcting the form, logging into the portal again and waiting another payment cycle. For a practice with a steady flow of insured clients, that is a real part of someone's week.
How we connect authorisations to the diary
- Each insured client gets an authorisation record: insurer, membership number, code, sessions authorised, expiry and any client contribution.
- Every booked and attended session counts against it automatically, from your booking system.
- Warnings go to the therapist and the practice manager when a set number of sessions remain, or when expiry is close, so an extension can be requested in time.
- Extensions are added as new blocks with their own codes, so each session is billed against the right one.
- Invoices are prepared per insurer in the format they need, with codes and dates filled in. Where an insurer offers a submission route we can use, we connect to it. Where they only accept a portal upload, we prepare the file ready to submit.
- Payments are matched back in Xero or QuickBooks and any client share is invoiced to the client separately.
The records hold billing and authorisation details only. Clinical reports insurers request stay in your clinical record and are sent by the therapist as usual.
What billing looks like after
You know how many sessions are left for every insured client before they walk in. Extensions are requested ahead of time. Invoices go out with the right codes and fewer come back.
The practice manager can see outstanding insurer payments by scheme, rather than finding them when the bank balance looks light.
Is your practice at this point?
- You have delivered sessions beyond what an insurer authorised.
- Insurer invoices come back for wrong codes or missing details.
- Authorisation emails are the only record of session limits.
- Client excess or shortfall payments are sometimes missed.
- You see clients through several insurers, each with its own process.