Health Insurance
Learn how to access physiotherapy through your health insurance, with simple guidance on claims and treatment options.
Health Insurance Policy Agreement
Company Name: The Fernandes Clinic Limited
Place of registration: England and Wales
Companies House Number: 16747901
Registered Office:
9 BARN CLOSE
PEASE POTTAGE
CRAWLEY
RH11 9AN
Principal activities Healthcare services as defined below.
Purpose of this Policy
This Health Insurance Policy Agreement establishes clear expectations for patients wishing to use private medical insurance to fund appointments at The Fernandes Clinic Ltd.
It ensures transparency, prevents disputes, and protects The Fernandes Clinic Ltd from liability arising from insurers, policy limitations, patient misunderstanding, or third-party administrative errors.
By attending the clinic and providing insurance details, you agree to the full terms of this agreement.
Patient Responsibility for Insurance Validity
It is the patient’s responsibility, not the clinic’s to confirm:
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Whether their policy covers physiotherapy, sports rehabilitation, sports massage, or acupuncture
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Whether the policy requires GP or consultant referral
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Whether their insurer requires clinical justification before approving sessions
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Whether their insurer covers treatment delivered by clinicians registered with HCPC/CSP
The Fernandes Clinic Ltd cannot be held liable for incorrect, outdated, misleading, or incomplete information provided by your insurance provider.
Patient Responsibility for Insurance Validity
Before any appointment funded by insurance:
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You must provide a valid pre-authorisation code
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You must confirm the number of sessions authorised
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You must confirm the expiry date of the authorisation
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You must provide your full policy information (membership number, DOB, address, insurer contact details)
If authorisation is not provided before the appointment, the session must be paid in full at self-funded rates.
Retrospective authorisation is not accepted under any circumstances.
No Liability for Insurance Rejection
If an insurer refuses payment for ANY reason, including but not limited to:
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Policy excess
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Policy exclusions
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Lack of referral
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Outdated authorisation
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Wrong CPT/clinical codes
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Administrative errors
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Claim submitted too late by insurer
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Claim system outages
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“Not medically necessary” decisions
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Policy changes
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Co-payment requirements
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Claim rejection without explanation
you, the patient, remain fully liable for the outstanding balance.
The Fernandes Clinic Ltd cannot intervene in disputes between you and your insurer.
Policy Excess & Co-Payments
Most insurance policies include:
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An annual excess, or
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A co-payment percentage/flat fee
These amounts are payable directly by the patient to the clinic.
The Fernandes Clinic Ltd is NOT informed automatically if your policy has an excess; therefore:
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When an insurer applies your excess, the claim is recorded as “paid to provider,” meaning we receive £0
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The full appointment fee becomes immediately payable by you
Unpaid excess or co-payment amounts may result in suspension of further treatment until the balance is cleared.
Insurance Shortfalls
If your insurer only pays part of our fee due to:
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Their maximum payable limit
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Their own internal pricing structure
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Their fee schedule not matching our fees
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Policy restrictions
The remaining balance becomes immediately payable by the patient.
We are not required to match insurer pricing.
Non-Covered Treatments
Some insurers do not cover:
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Sports massage
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Strength & conditioning sessions
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Long appointments (60+ minutes)
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Preventative therapy
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Maintenance care
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Acupuncture
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Electrotherapy
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Reports, letters, or administrative fees
You will be informed if the session you request is not eligible for insurance funding.
If you choose to proceed, the full self-funded fee applies.
Late Cancellation & Missed Appointments (Insurance Clients)
Insurance companies do not pay for:
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Missed appointments
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Late cancellations (less than 24 hours)
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No-shows
If this occurs, you will be charged the full self-funded price, regardless of policy coverage.
This charge cannot be claimed from your insurer under any circumstances.
Insurance Authorisation & Policy Compliance
Patients must not:
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Provide false Authorisation Codes
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Provide codes belonging to another person
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Misrepresent symptoms to gain authorisation
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Attempt to use an expired or invalid authorisation
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Provide misleading information to bypass insurer rules
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Manipulate appointment logs to meet policy requirements
Such actions may result in discharge from the clinic and insurers being notified.
Direct Billing and Claim Submission
The Fernandes Clinic Ltd will submit claims electronically or manually to your insurer as required.
However, we cannot guarantee:
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Payment times
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Processing times
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Acceptance of claims
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Insurer administrative performance
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Accuracy of insurer correspondence
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System reliability of insurers
You remain legally responsible for all fees relating to your care.
Disputed Invoices
If your insurer disputes or delays payment for any reason, the full fee automatically transfers to patient liability until the matter is resolved.
The clinic will not enter financial disputes between the patient and insurer.
Termination of Insurance Billing
The Fernandes Clinic Ltd reserves the right to discontinue direct billing if:
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Claims are repeatedly rejected
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Patients fail to pay excesses or shortfalls
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Patients repeatedly provide incorrect information
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Insurers are consistently slow to process claims
In such cases, the patient must pay upfront and claim reimbursement themselves.
Limitation of Liability
To the fullest extent permitted by UK law:
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The Fernandes Clinic Ltd is not liable for financial loss arising from insurer behaviour
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The clinic is not responsible for insurer errors, delays, or rejections
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The clinic is not responsible for coverage gaps, excess, or policy changes
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The clinic is not liable for losses caused by insurer disputes
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The clinic is not liable where the patient failed to understand their own policy
Your use of private medical insurance is entirely at your own risk.
Agreement
By booking an appointment at The Fernandes Clinic Ltd using health insurance:
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You confirm that you have read and understood this document
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You accept full personal responsibility for all fees not paid by your insurer
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You agree that liability for payment rests with you at all times