Private medical insurance, Healthcode and insurer-funded GP work: how billing works

How insurers treat GP care

UK private medical insurance (PMI) is built around specialist care. For GP care, insurers mostly provide their own service:

• AXA Health says it doesn’t usually cover face-to-face GP appointments and includes an online GP service as standard. Its small-business Private GP option reimburses up to £500 a year for each person on the plan for private GP visits.
• Bupa offers consumer health insurance customers a 15-minute face-to-face GP appointment at a Bupa health centre for one acute minor illness. That is Bupa’s own service, not a benefit for an outside GP.
• Aviva gives members its Digital GP app, which it describes as a non-contractual benefit.

So most patients with PMI will still pay you themselves. Some can claim part of the cost back. For more on what patients can claim, see can patients pay with insurance?

The ways you get paid

Model	How it works	What you need
Self-pay	The patient pays you at booking or on the day. If their policy reimburses GP visits, they claim with your receipt.	Clear prices, card payment and itemised receipts
Insurer direct billing	You invoice the insurer against the patient’s authorisation. The patient pays any excess or shortfall.	Recognition by that insurer, a provider number and e-invoicing
Employer or corporate contract	A company pays for its staff’s appointments or health checks, often monthly	A written contract, consent to share, and invoicing to the company
Reports and medicals	An insurer, employer or solicitor pays for a report	The patient’s consent, the right fee, and a check on the VAT treatment

Insurer recognition comes first

An insurer will only pay you directly if it recognises you. Each insurer has its own criteria and application process, and each gives recognised practitioners a provider number. Many GPs never apply, because GP benefits are limited and the admin is real. It is worth doing if:

• you see many patients through a corporate scheme or a local insurer arrangement
• you offer services insurers do pay for, such as some diagnostics or minor procedures under a specialist pathway
• patients often ask whether you are recognised by a particular insurer

Healthcode runs a register where practitioners store their practising information and documents, and insurers use this data when they process recognition. Check each insurer’s own requirements before you apply.

What Healthcode does

Healthcode is the clearing house most UK private practitioners use to invoice insurers electronically. Its clearing service sends invoices to the major payers from one system. It names Alliance, Allianz, Aviva, AXA, Bupa, Cigna, Healix, Exeter, Vitality and WPA.

• Cost: a £9.20 monthly subscription from 1 April 2026, plus a fee per invoice of about 27p to 54p, invoiced monthly and subject to VAT, at the time of review.
• Who can use it: a “payee provider”, meaning a practitioner or practice recognised by an insurer that is paid directly by it.
• Practice software: Healthcode also sells ePractice, a practice-management and billing product.

Insurers code procedures and consultations using the CCSD schedule, which Bupa, Vitality, AXA Health and Aviva maintain together. Its consultation codes are written for specialist consultations. Before you invoice a GP consultation, ask each insurer which code it expects.

Before you see an insured patient

1. Ask for the insurer, the membership number and any authorisation or claim reference.
2. Check with the insurer, or ask the patient to check, what the policy covers and any limit or excess.
3. Tell the patient your fee, and get their written agreement to pay anything the insurer does not.
4. Record the authorisation in the patient’s record, and invoice promptly with the codes the insurer expects.

Payment timing depends on each insurer’s payment cycle, so track insurer invoices separately from self-pay income and chase them regularly.

Employer-funded work

Corporate contracts can bring steady volume. They also matter to the employer’s tax position. HMRC treats one health screening and one medical check-up a year for each employee as exempt from benefit-in-kind tax. Medical treatment the employer pays for is generally a taxable benefit. Set out in the contract what the employer receives. Usually that is attendance and fitness outcomes, not clinical details, unless the employee gives specific consent.

Insurance reports

Life and income protection insurers often ask for a GP report. The BMA recommends £104 for a GP report for an insurance applicant, a figure last agreed in 2006, and suggests charging your private rate for PMI reports. If you have been responsible for the patient’s clinical care, the Access to Medical Reports Act 1988 lets the patient see the report first. You must not send it until they have had access or 21 days have passed since the application.

Reports done mainly for a third party are usually standard-rated for VAT, unlike most medical care. See VAT for private GPs.

Common problems

• No authorisation. An insurer can refuse an invoice for care it did not authorise. The patient then owes you the full fee, so say this in your terms.
• Tests on the same day. The policy may cover the consultation but not the blood tests. Itemise every invoice so the patient knows what they are paying. See charging for tests.
• Onward referrals. Insurers usually want a referral before specialist care. Check what format they need, and whether they accept a referral from a private GP.
• Remittances that don’t match. Reconcile insurer payments against invoices every month, and follow up on part-payments quickly.

Showing prices

The CMA’s 2014 private healthcare order makes consultants publish their fees and say which insurers recognise them. It defines consultants to exclude general practice, so it does not apply to most private GPs. General consumer law on clear, upfront pricing still does. See how much to charge and collecting payment.