Managing self-payers correctly?

Simon BrignallUncategorizedLeave a Comment


Managing self-payers correctly?

Self-pay patients account for nearly 50% of our billing now due to the shift to patients using private healthcare as a ‘pay-a-you-go service’ – and sparking a rise in consultants’ shortfalls.

The big swing to self-pay continues and consultants need to be on top of the game to ensure they get fully paid for the increased amount of work they are doing for their patients.

Private medical insurance work now accounts for less than half of our billing total. The largest second sector is the self-pay market.

The figure is an average across our consultants and can vary dependent on specialty, although in many cases it is significantly more.

The reasons for the growth in self-pay is down to a number of factors. Let’s deal with the main ones in turn:

Insurance policies

To try to control premiums, insurance companies have areas that are not covered by the policy.
Also, for more long-standing consultants, a larger proportion of the patient’s invoice is now shortfalled as a self-pay invoice.

Overseas patients

For practices based in central London, this has always been a part of any practice with non-UK patients seeking high-quality private healthcare.


With the growing pressures on NhS waiting times and some of the concerns raised in the media regarding quality of care, many patients are turning to private healthcare for specific treatments.


There has always been a number of patients who have sought out private healthcare without an insurance policy. given the changes in private medical insurance payment structures and people taking a tighter control of their finances, this area is the fastest growing area of patient referral.

The reason all this information is important is if you do not know the statistics of your own practice, you cannot make sure that it gets dealt with correctly for the billing and collection process.

In our 26 years of experience, this is rarely dealt with in the proper way. On so many occasions, there is a lack of clarity regarding the billing and collection for selfpay patients. This can result in a slowly increasing spiral of debt for the practice.

The reasons for the debt can be down to a number of factors. but, typically, what we see is a lack of a robust process to collect the debt. The practice needs to have a system to deal with each and every self-pay patient.

Overseas patients

When you are seeing a patient from outside the UK, you will need to be clear what your charges will be so they can be advised in advance of the full costs of treatment. And you will also need to be clear on their payment method.

When we deal with these patients, we often collect payment in advance, as once the patient has left the UK, there may be difficulties chasing the debt.

A common way of taking on an overseas patient is through the hospital. in many cases, the hospital will agree to recover your fees from the patient. however, unless you invoice the correct contact in the hospital in a timely manner, your fee will not be collected.

UK self-pay

The majority of consultants have a growing element of patients who are self-pay. Therefore, they should be provided with a price list and have agreed payment methods made clear in advance. This way, the patient is aware of the figure they will be invoiced, avoiding a later dispute on costs.

While taking payment, we have a variety of methods available, including taking payment on the day or in advance. Our payment portal is always open for credit card or debit card payments.

If you cannot take payment on the day, then you will need a robust system where the patient is politely reminded after an agreed time then chased on a regular basis until payment is collected.

Insured shortfalls

Depending on your specialty and how long you have been in private practice, you may have a level of shortfall on all or some of your self-pay invoices.

This is the hardest to collect, as many patients do not fully understand their policy and wrongly assume that all costs are covered (see page 44).

The result can be they are surprised to see the shortfall invoice and choose to ignore it, as they assume that it should have gone to the insurer. if these invoices are not called and chased, they invariably remain unpaid.

Once many patients are aware of the invoices following a call, they dispute it with their insurer. in fact, a large amount of our work is liaising between patient and insurer to ensure the patient is made aware it is their liability.

Once the patient accepts liability, then you can discuss payment of the invoice.

Economic pressure

The continuing economic pressure has decreased incomes in real terms over the last years for many people. This means a robust system as described in this article should be in place.

If you don’t have one, then the debt will become older and increasingly difficult to chase. The alternative is to chose to use a billing and collection company with the expertise and processes in place to manage this for you.

This, in turn, allows you to concentrate on the medical side of your practice without the burden of dealing with debt.



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  • Medical Billing & Collection
    Connery House
    Repton Place
    Buckinghamshire HP7 9LP

More than Just a Billing Company


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