A patient rings and asks whether the clinic takes her insurance. It is the first question, it decides whether she books anywhere at all, and the answer is a two minute conversation that happens forty times a month.
It is also a commercial decision most clinics have never actually made.
When accepting insurance work makes sense
It makes sense when the rates are acceptable, when the administration is manageable, when the volume fills appointments that would be empty and when payment arrives predictably.
When to decline
Decline when the rate is below what the time is worth, when authorisation processes consume staff hours, when payment runs to months, or when the clinic is already full of self-pay patients at a better rate.
Publish which insurers you work with
By name. Patients check this before anything else and a clinic that lists them appears in exactly the searches those patients are running.
Explain what the patient must do
Check their own cover, obtain any authorisation, know their excess and understand their session limit. Clinics cannot do this for them and patients assume otherwise.
Never interpret a policy
Whether a policy covers something, what an excess means for a particular claim and how many sessions are authorised are matters for the insurer. A clinic explains its own arrangement and nothing more.
Explain the payment arrangement
Whether you bill the insurer directly or the patient pays and claims. This is the most consequential practical difference and it decides whether someone can afford to start.
Publish the self-pay rates alongside
Patients with no cover, or whose sessions are exhausted, need the alternative visible. Many end up self-paying after a course of authorised sessions.
Explain what happens when authorisation runs out
How the patient is told, what continuing costs and whether a break is advisable. Patients discovering this mid-course feel ambushed.
Employer referrals are a different channel
Occupational health providers and employers send patients with their own processes, reporting expectations and rates, which behaves like GP and clinic referral questions for private testing.
Explain how the excess works in practice
Patients know they have an excess and rarely know how it applies across a course of treatment. Explaining whether it is taken at the first appointment, spread across sessions or settled with the insurer afterwards means somebody arrives knowing what they will be asked to pay on the day rather than being surprised at a reception desk.
Decide about reporting
Employer-funded work often requires a report, which is real work and should be priced separately rather than absorbed.
Keep consent clear on funded work
Where somebody else pays, what is shared and with whose consent must be explicit before the first appointment.
Publish what the insurer will be told
Patients assume a claim involves a form and nothing more, and are uneasy when a clinic mentions reports or session summaries. Setting out what is submitted to an insurer, what clinical detail it contains and what consent covers it means somebody decides knowingly whether to claim or simply pay, which some patients choose once they understand it.
First appointments need explaining regardless
They are covered in new patient questions before a first adjustment, and sensitive enquiries need the care in pregnancy and paediatric enquiries handled carefully.
Getting started
Publish which insurers you work with, the payment arrangement and your self-pay rates, then answer at any hour without interpreting anyone's policy. SpideyChat for chiropractic clinics answers from your published pages, much as described in how chiropractic clinics book new patients with a chatbot. Try SpideyChat on your own site, or read about answers on the features page.