Guide
Private Medical Insurer Fee Reviews for Physio Clinics: How to Request a Fee Increase
This guide explains how to handle an insurer fee review, what evidence strengthens a fee increase request, how to approach Bupa and other insurers, and what to do if the answer is no.
FAQs
Potentially, but Bupa’s physiotherapy network uses agreed fees and there is no guarantee an individual increase will be accepted. Check your current network terms and make a specific, evidence-led request through the relevant provider route.
Current and proposed fees, self-pay and market benchmarks, changes in your cost base, insurer-related admin effort, specialist capability, outcomes data where available, treatment averages and any evidence that your service is difficult to replace locally.
Competition law restricts competitors from coordinating prices or exchanging future pricing intentions. Clinic owners should make pricing and insurer decisions independently. You can compare with publicly advertised self-pay prices at similar clinics in your area, alongside wider industry benchmarks.
Not automatically. The right decision depends on the clinic’s capacity, patient flow, costs, insurer dependence and the contractual consequences of leaving.
A practical guide for physiotherapy clinic owners and managers
Private medical insurer fees do not always move in line with a clinic’s self-pay prices or operating costs. That does not automatically mean an insurer will increase your rate, but it does mean clinic owners should review the relationship deliberately rather than allowing an old fee to roll on indefinitely.
Can physios negotiate insurer rates?
Sometimes. Many practice managers and clinic owners have successfully negotiated terms with private medical insurers, but usually only where they can make a compelling business case. The important point is that the clinic must make its own commercial decision: not every insurer operates the same fee model, and not every rate is individually negotiable.
There are real examples of successful individual requests. One practitioner reported receiving a 14.3% AXA fee increase in 2020 after submitting their self-pay fees and a supporting case. Another practice owner retained a higher Bupa rate after outlining their specialist qualifications, equipment and skill mix. These are useful examples of what can strengthen a request, but they are historical cases rather than guarantees of how either insurer will respond today.
The strongest lesson from those clinic owners is simple: know your numbers before you ask. In both examples, the insurer represented only a small share of the clinic’s activity, so the owner knew what they would do if the request was refused.
When should you review your insurer fees?
A sensible default is to review insurer fees at least annually, and sooner if the economics have changed materially. Physio First and others specifically recommend revisiting PMI rates each year, even if only to test whether there is a credible business case for an increase.
Exemplar reasons to review your insurer fees:
• Your self-pay fees have increased materially while an insurer rate has stayed unchanged.
• Staff, premises or other operating costs have risen.
• Insurer work now creates significantly more administration, reporting or billing effort (p.s. Effra can automate your billing end-to-end!)
•. Your diary is consistently busy, so lower-rate appointments increasingly displace higher-value work.
• The insurer has become a meaningful share of clinic revenue, making the economics worth reviewing closely.
Do the profitability check before the fee request. Your calculation should include more than treatment time: clinical records, reports, invoicing and administration all affect the real cost of insurer work. For a fuller way to assess whether PMI work makes commercial sense for your clinic, use Effra’s guide and PMI calculator.
Useful benchmark: the 2026 UK Private Practice Barometer found median physiotherapy prices of £74 for an initial consultation and £63 for a follow-up, based on 233 physiotherapy respondents. Across the wider private-practice sample, 73.5% of clinics had increased prices in the previous 12 months. Treat this as a market benchmark, not proof that an insurer should match self-pay pricing. |
What makes a strong case for a fee increase?
The evidence from clinic owners is consistent: a commercial case is stronger than an argument about fairness. Insurers need a reason to believe the clinic is worth paying more for, or that keeping the existing rate creates a real risk to access, quality or the provider relationship.
Prepare these before making the request:
• Your current insurer fee and when it was last reviewed.
• Your current self-pay fee and, where useful, credible local or national benchmarks.
• The change in your cost base since the insurer fee was last set.
• The admin time involved in insurer work, including records, reports, authorisation queries, invoicing and payment handling.
• Specialist qualifications, advanced services or equipment that distinguish the clinic.
• Patient outcomes, PROMs/PREMs or other evidence of quality where available.
• Treatment averages and the context behind more complex cases.
• Evidence that your service is difficult to replace locally, for example specialist expertise or limited alternative provision.
• The specific fee you are requesting.
Recent professional discussions reinforce the value of outcomes evidence. In 2026, Physio First reported discussions with both AXA and Aviva around complexity, outcomes and the value of experienced physiotherapists. The direction of travel is clear: a clinic that can demonstrate value has a stronger case than one relying only on “our rate is too low”.
What is less persuasive?
A generic argument that a fee is “unfair”, or that patients should simply have more choice. Physio First’s practitioner guidance is explicit that these points carry little commercial weight without a stronger business case.
How do I request a Bupa (or other insurer) fee increase?
1. Check your current agreement
Confirm the current fee, the contract or network terms that apply to your clinic, and whether the insurer provides a route for an individual review. Do not assume the process is the same across insurers.
2. Prepare the evidence
Pull together the commercial and clinical evidence above before contacting the insurer. Keep it short enough that the reviewer can see the case quickly.
3. Ask for a specific fee
State the current fee, the new fee you are requesting and the reasons for the change. A specific commercial proposal is stronger than asking vaguely for “a review”.
4. Explain the value of retaining your clinic
Where true, include specialist capability, local scarcity, outcomes, access or other factors that make the relationship valuable to the insurer and its members.
5. Record the outcome
Keep the date, contact, proposed rate, insurer response and next review date in one place. If the answer is no, you will then have a clear record for the next review.
How do fee reviews differ between Bupa, AXA, Aviva, Vitality and WPA?
The biggest mistake is treating “insurer rates” as one standard model. Current public information shows materially different approaches, so clinics should check their own contract and provider terms before deciding how to proceed.
Insurer | What to know |
|---|---|
Bupa | Its physiotherapy network operates on agreed fees. If your clinic wants a different rate, check the current network terms and contact the relevant provider team rather than assuming there is a standard fee-increase form. |
AXA Health | Physio First documents historical examples of individual fee negotiation, but the route and criteria can change. Check the current provider terms before relying on an older process. |
Aviva | Recent professional discussions describe a national fee structure, with Aviva indicating in 2026 that it viewed the current structure as broadly working. This makes evidence of clinic value and commercial sustainability particularly important. |
Vitality | Vitality currently publishes a £35 physiotherapy therapist fee and requires recognised therapists to agree to its fees. That is a different starting point from an individually negotiated clinic tariff. |
WPA | WPA distinguishes Fee Agreed providers from other recognised providers. Its terms allow a Fee Agreed provider to leave that status, subject to conditions for existing bookings and pre-authorisations. Check your status and terms before making any change. |
What should you do if the insurer refuses your fee increase?
Decide your walk-away position before you make the request. A refusal does not automatically mean the clinic should leave the insurer:
• Accept the rate if the patient flow and contribution are still worthwhile for your clinic.
• Reassess the relationship if the rate is becoming less attractive as your diary fills or costs increase.
• Leave or change the relationship if the work is no longer commercially sustainable and the clinic can absorb the likely reduction in patient volume, subject to the contract terms.
Do not bluff. Historic examples are useful precisely because the owners knew their exposure before negotiating. One clinic spoke to Physio First and said AXA cases represented about 3% of turnover; another clinic said Bupa represented less than 4% of patient volume. Those figures are not recommended thresholds, but they show why dependence matters.
Can clinic owners discuss insurer rates with other clinics?
Be careful. Clinics can independently assess their own costs, set their own commercial position and make their own fee request. But the Competition and Markets Authority warns private practitioners against coordinating prices, agreeing how fees should be set, or discussing future pricing intentions with competitors. Current prices can also be commercially sensitive.
That means owner forums can be useful for understanding common operational problems or historical experiences, but your clinic’s fee decision and response to an insurer should remain independent. This is a competition-law issue, so seek legal advice if you are unsure about a proposed collective initiative.
Please note, you should still determine local benchmarks as this forms an important part of your evidence to present to insurers at fee review. You can do this with publicly advertised self-pay prices at similar clinics in your area, alongside wider industry benchmarks.
The takeaway
An insurer fee review should be a commercial exercise, not an argument about whether the rate feels fair, despite the strong feelings you may have towards the insurer(s). Know what the insurer relationship is worth to your clinic, build a short evidence-led case, ask for a specific rate, and know in advance what you will do if the answer is no.