Year published: 2022
A Private Medical Insurer (PMI) is an organisation that funds healthcare for individuals through insurance policies. Patients may access physiotherapy as part of their cover, subject to the insurer’s terms and conditions.
Working with PMIs is a business decision, not a professional requirement. Many physiotherapists choose to work with insurers, while others focus on self-pay, NHS, or occupational health services.
Physiotherapists and clinics can decide which insurers they will work with based on:
- Fees
- Administrative requirements
- Alignment with their business model
Clinical decision making remains the responsibility of the physiotherapist although funding arrangements may influence the duration of care and the reporting requirements.
Frequently Asked Questions
Can physiotherapists negotiate fees with insurers?
- Physiotherapists can choose whether or not to accept an insurer’s fee structure, but collective negotiation is not permitted under competition law.
- Each practitioner or clinic must make independent decisions about whether a contract is commercially viable.
How are treatment sessions authorised?
Most insurers require:
- An initial referral or GP/consultant involvement (depending on policy)
- Pre-authorisation for treatment
- Agreed limits on number of sessions
Processes vary between insurers and are typically managed through online provider portals. There are often limits on treatments. Insurers may:
- Set a maximum number of sessions
- Require review points
- Specify treatment pathways
What happens if a patient needs more treatment than their policy allows?
Patients can usually:
- Self-fund additional treatment
- Be discharged with advice and self-management strategies
- Be referred to alternative services if appropriate
- Clear communication with patients is essential
How can physiotherapists demonstrate value to insurers?
Collecting and using outcome data is becoming central to engagement with insurers. Value can be demonstrated through:
- Patient-reported outcome measures
- Functional improvement
- Efficient use of treatment sessions
- Return-to-work outcomes (where relevant)
CSP advice on insurance rates
The CSP believes that private and occupational health insurers and intermediaries should:
- Recognise the rising costs of providing face-to-face physiotherapy
- Pay a fair rate for online and telephone consultations
- Ensure all regulated professions are equally remunerated.
The CSP is concerned that members who own small businesses are facing rising costs but these are not being recognised by insurers.
The increased use of online appointments has not reduced the fixed costs many independent practitioners face.Independent physiotherapists deserve to be paid a fee that reflects the skills of chartered physios and the costs they face, and which gives parity with other professions. Many self-employed members have low take-home incomes after practice expenses. Effectively they are being asked to take pay cuts by some insurers.
We have long been advised that competition law prevents the CSP, in line with all other professional bodies, from seeking to negotiate rates for private practitioners. The CSP is working to secure changes to the law to allow us as a union and our members to redress the power imbalance in the market. Until a change in the law, it is for individual physios and businesses to determine whether to accept rates offered by insurers.
In deciding what fees are reasonable the following factors should be considered:
- Time – this is not just the time for a consultation but also the time: writing reports, recording notes and insurer required administration.
- Experience – if you are providing services requiring postgraduate specialist training or experience, this should be reflected in fees.
- NHS hourly pay rates may help you consider what cost is reasonable in relation to time and experience.
- Practice costs – Fees need to cover your costs as well as recognise time and skill. Providing your service will involve you meeting a wide range of costs that need to be covered including: business insurance, HCPC fees, CSP membership, other specialist network fees, ICT costs, accounting, PPE, premises, travel costs, medical supplies, CPD and more.
- Opportunity cost – Is the fee at least on a par with what you could earn from another source? Consider what alternative income you might earn in the same time, for example from patients paying directly or NHS bank work.
The CSP advises that members should not accept rates that undervalue them or which don’t reflect the full costs of providing advice or treatment.