Deferred payment is nothing new in the healthcare sector. The national Diapason scheme, led by the Ministry of Health, already allows many hospitals to secure the out-of-pocket expenses charging patients via bank card pre-authorisation once treatment is complete. A recognised and legally regulated practice.
However, it remains limited to public and private non-profit health facilities. Private clinics and fee-setting independent practitioners are excluded, even though they face the same problem: out-of-pocket costs whose amount is only known after Social Security and the supplementary health insurance have responded.
This is the area covered by deferred payment via bank card pre-authorisation in the private sector. Let's look at how it works, the legal framework, and what it means for an administrative office.
Sector 1, Sector 2: two very different payment systems
In sector 1, the doctor charges the fee set by the national agreement, with no extra billing. The patient's out-of-pocket expense is therefore known in advance and covered almost entirely by the state health insurance and top-up health insurance. This is not strictly «no upfront costs in every case» (full third-party payment remains reserved for certain situations such as CSS, AME, ALD or maternity), but the final amount does not change and the payment issue is resolved simply.
In sector 2, it is a different story. The practitioner can apply extra billing, framed by the principle of tact and moderation. The problem is that the portion reimbursed by the top-up insurance for these excess charges varies enormously depending on the policy. As a result, the exact amount of the out-of-pocket expense is often only known’after reimbursement from the NHS and the top-up insurance, sometimes several weeks after the procedure.
The real challenge: securing a payment where the amount is not yet known
That is where it gets complicated for secretaries. You have to track the file, chase the patient, cash a cheque, deposit it, sometimes start all over again because the patient forgot or is no longer replying. For a practice or clinic with high volume (anaesthetics, orthopaedics, ophthalmology), this chasing time quickly adds up, and a proportion of these files end up as unpaid debts, for a real cost often higher than it appears once management time is factored in.
Why can't we just charge the patient in advance
First idea that comes naturally: take a sample from the patient before the procedure. Except that it's not legally impossible. Article R.4127-53 of the Public Health Code, which incorporates the Code of Medical Ethics, is clear: fees may only be claimed for procedures actually performed. A doctor cannot charge for a procedure that has not yet taken place. This is not a matter of good practice; it is a substantive rule.
Second possible option: the deferred debit card, which takes payments at the end of the month rather than at the time of the transaction. Appealing on paper, except that not all patients have one. It is therefore not a system on which a practice or clinic can build its organisation.
How deferred payment by bank card pre-authorisation works
The principle: at the time of the appointment, the establishment takes a card pre-authorisation on the patient's card, a simple 0 euro test transaction which does not debit anything, does not block any funds and does not impact their ceiling. Once the procedure has been carried out and the amount remaining to be paid is known, following feedback from the Social Security and the mutual insurance company, the establishment schedules the’payment of the exact amount, in due course.
The National Council of the Order of Physicians itself confirmed, in its commentary on the Code of Ethics, that taking a bank card imprint is ethical, provided that the patient is informed beforehand that payment will only take place after the procedure, and that the procedure has indeed been carried out. We detail how it works in a dedicated article.
What it changes on a daily basis
For the attention of the secretaries
- No more chasing patients week after week
- No more managing cheques to be cashed and deposited
- The teams that switch to this type of solution say it themselves: they save time 6 hours a week patient chase-ups
For the practitioner
- Fees are secured without placing any further administrative burden on the secretarial team
- The patient has nothing to pay upfront even before the procedure has taken place
- The remaining balance is paid at the right time, once the actual amount is known
Worth noting all the same: it is not a magic solution that eliminates all unpaid bills. In practice, it makes it possible to reduce unpaid bills by 80 to 90% (a card may have expired or have insufficient funds on the day of processing, which explains the remaining delta). What really changes is the mechanics: instead of chasing a payment, you secure it beforehand and process it at the right time.
Frequently asked questions
Yes, provided that the framework of Article R.4127-53 of the Public Health Code is respected: the patient must be informed beforehand that payment will only take place after the procedure, and the procedure must actually have been performed.
Yes. The public sector has been using it for several years via the national Diapason scheme. The private sector (clinics and fee-setting practitioners), on the other hand, does not have access to this scheme and must use dedicated solutions.
The card authorisation is a zero-euro test transaction that verifies the card is valid, without debiting or blocking any funds. The payment is only taken afterwards, once the remaining balance amount is known.
No. The patient is informed at the time of the appointment that the bank card pre-authorisation will only be charged after the procedure, for the exact amount of the remaining balance, once this is known following returns from the Social Security and supplementary health insurance.
Swikly, a deferred payment solution designed for the sector 2
Swikly is based on the same principles as those already validated for the public hospital sector with Diapason, but designed for private clinics and self-employed sector 2 practitioners who do not have access to this system. The healthcare solution is based solely on a’bank imprint, with no blocking of funds and no impact on the patient's limit. It is primarily aimed at practitioners and healthcare facilities that handle high volumes: anaesthetists, orthopaedic surgeons, ophthalmological surgeons, private clinics. It integrates with business software such as Web100T (Dedalus) or Diane (Bow Médical), so that the signature is sent automatically when an appointment is booked, without changing the secretariat's working habits.
Would you like to know if Swikly is compatible with your business? Book an appointment with our team or consult our health page.
