Before an insured patient's first physio session, you need four things settled: that their policy covers physiotherapy, which referral route their insurer wants, that the claim is authorised, and that the insurer recognises your clinic or therapist. Get those at booking and the treatment gets paid. Skip them and you may end up chasing a patient for an invoice they thought their insurer was paying.
Why does this go wrong so often?
Because the patient usually believes "I'm covered" means everything is sorted, and the person taking the booking is busy. The details sit in the insurer's terms, which vary by insurer and by policy.
Take one example. AXA Health's Personal Health handbook (April 2026) shows how many conditions can sit behind a single physio claim (AXA Health Personal Health handbook, April 2026):
- Physio is part of a Therapies Option, extra cover the member may or may not have.
- Treatment must be referred by a GP, or arranged through AXA's own muscles, bones and joints service without a GP referral.
- The member must see a therapist AXA recognises. The handbook says: "Please call us before you start treatment so we can confirm whether we recognise your therapist. If you choose to use a therapist that we do not recognise, we will not pay for your treatment."
- Cover is up to an overall maximum of ten sessions a year, with more only if a specialist refers and AXA agrees first.
- Members can pre-authorise treatment online or by phone.
That is one policy from one insurer. Others work differently, which is exactly why your booking process should ask rather than assume. The Chartered Society of Physiotherapy's guide to private practice lists insurance companies alongside GPs, consultants and self-referral as routes by which private physios receive patients (CSP and Physio First, Private Physiotherapy Practice: The Essential Guide), so most clinics will see a mix.
What should you ask when an insured patient books?
| Ask | Why it matters |
|---|---|
| Which insurer, and is the policy personal or through an employer? | Different insurers, different rules |
| Policy or membership number | Needed for the claim and for any queries |
| Have you contacted your insurer about this condition yet? | Many policies need the claim opened before treatment |
| Authorisation or claim number, if you have one | Your proof the claim exists |
| How many sessions have been authorised? | So you know when cover runs out |
| Did they ask for a GP or specialist referral? | Some routes need a referral letter |
| Did they confirm they recognise our clinic or therapist? | An unrecognised therapist may mean no payment |
| Is there an excess on your policy? | That part is the patient's to pay |
| Is the insurer paying us directly, or are you claiming back? | Decides who you invoice |
If the patient has not contacted their insurer yet, the simplest answer is to give them a provisional slot and ask them to call the insurer first, then come back with the authorisation number. Make it clear in writing that if the insurer declines, the session is charged at your self-pay rate.
Who pays what?
Three questions decide who gets the invoice:
- Does the insurer pay the clinic directly or reimburse the patient? Your terms should say which you accept.
- Is there an excess? If so, agree how you collect it, usually at the first session.
- What if the insurer declines, or sessions run out? The patient should know before treatment starts that they become a self-pay patient from that point.
Put all three in your insured-patient terms and send them with the booking confirmation.
How do you avoid running past the authorised sessions?
Track it. Record the number of sessions authorised on the patient's file, count them down at each visit, and tell the patient before their last authorised session. If more treatment is clinically needed, that is the point to ask the insurer for more sessions, with whatever progress report they require. In the AXA handbook quoted above, more sessions beyond the yearly maximum need a specialist referral and AXA's agreement first.
Where does the phone fit in?
Most of this information is gathered on a call or in a message, often in the evening, after the patient has finished a long call with their insurer. If nobody answers, the patient may simply book with whichever clinic their insurer suggests.
Remi answers your clinic's phone, WhatsApp and email at any hour and books straight into Cliniko, Acuity or Google Calendar, or texts your booking link. Where insurance details need checking by your team, it takes a detailed message with what the patient has told it, so the morning starts with the facts instead of a voicemail. If you want to see how that works for a clinic that takes both self-pay and insured patients, here is how an AI receptionist for physiotherapy clinics handles bookings.
Checklist: insured patient, first booking
- Insurer name and policy or membership number recorded
- Patient has contacted the insurer and has an authorisation or claim number
- Referral route confirmed (GP, specialist, or the insurer's own service)
- Insurer recognition of your clinic or therapist confirmed
- Number of authorised sessions recorded on the file
- Excess amount and how you will collect it agreed
- Direct billing or patient reimbursement agreed
- Patient told, in writing, that sessions not covered are charged at your self-pay rate
The short version
An insured physio booking is only safe once you know four things: the policy covers physio, the referral route the insurer wants, the claim is authorised, and the insurer recognises your clinic. One AXA Health policy, for example, requires a GP referral or its own muscles, bones and joints service, caps cover at ten sessions a year, and will not pay an unrecognised therapist. Ask the same questions at every insured booking, record the answers, track sessions used, and tell patients in writing what they pay if cover runs out.