Embarking on a diplomatic mission?

If you are thinking of expanding your private work to provide services for embassies, then there are some essential billing and collection matters you need to be aware of, suggests Simon Brignall.

Consultants in private healthcare are often looking to new business opportunities to grow their practice and that can include a wide range of revenue channels. 

It certainly makes good sense to review your practice regularly, as there are many areas outside of the traditional private medical insurance (PMI) and self-pay sector where a consultant can operate and generate additional revenue.

It is important for any business to have diverse revenue streams from a variety of sources so that if a particular source of income tails off, the effect on the business is minimised – and private practice is no exception.

The range of options available can depend on where you are located or the type of activity you are prepared to consider. 

Revenue channels include:

 Medico-legal; 

 NHS (Choose and Book);

 Commercial organisation – this can include billing corporates to treat their staff or consultancy work;

 Provision of courses and seminars;

 Embassies.

With embassy work having taken a bit of a dive during Covid, let us look at what you need to know from a billing and collection perspective if you are thinking of including this sector as part of your patient mix. 

For consultants working in London, international patients make up a significant proportion of the patients they treat. 

These are predominantly international self-pay patients, and I have covered in detail the billing issues that impact this group in my recent article on self-pay, but a significant proportion will be patients that come from the embassies.

The demand from international patients accessing healthcare in the UK saw a significant reduction as the impact of the coronavirus, including lockdowns and travel restrictions, were felt by travelling patients. 

This area is starting to recover as the benefits of vaccination programmes in all countries begin to take effect and both confidence and access to international travel returns. 

There are over 50 embassies within London; however, most of the patients come from the big four, which are Kuwait Health, Kuwait Military, United Arab Emirates Medical and Qatar. 

Here are some important things you need to be aware of should you decide to treat this important patient category. 

Complex nature of patients

The patients that you will be sent by the embassies often have complex conditions and this is one of the main reasons why they travel to this country. These can include patients whose previous procedures/treatments were unsuccessful or require revisional surgeries.

Extra time required

When you see the patients for their consultation, they will normally be accompanied by an interpreter. This, in combination with the probability of the patient presenting with a complex case, means that the consultation is likely to take longer than normal and so you will need to allow more time in your clinic diary. 

Necessary documentation

Before seeing an embassy patient, it is crucial that you obtain a letter of guarantee – referred to as LOG. The LOG will authorise treatment for the patient and it is important that is issued in your name. This is a precursor to raising an invoice to an embassy, as, without this vital document, it is unlikely that the invoice will be paid.

Cash flow

Probably the most important point to consider about undertaking embassy activity is that payment often can take a long time. The impact this can have on a practice’s cash flow should be understood and may limit the amount of this type of activity you undertake when compared to other patient groups with faster payment cycles.

Embassy check-list

In our experience, many consultants start seeing embassy patients without having given due consideration to the points that I have highlighted above and so here is simple guide to help you.

Letter of guarantee 

It is absolutely vital that a letter of guarantee (LOG) is obtained prior to any treatment that is carried out; this document will vary slightly depending upon the embassy that is issuing it. 

It will typically specify the patient’s demographic details along with the appointment date(s), the reason for the treatment as well as specifying the consultant and the location. 

An important check is to ensure that the dates specified in the LOG cover the treatment dates that are on the invoice, as this can often be a reason an invoice is rejected. 

There is normally a set of terms and conditions covering the LOG and you must always submit this document in conjunction with your invoice to the embassy in a timely manner to ensure the best possible chance of receiving payment. 

Some embassies also require a medical report along with the invoice and LOG. If this process is not followed correctly, then you run a much greater risk of treating patients without getting paid. 


How much you want to charge for your treatment needs careful consideration before you start to see patients. 

Your fees may consist of a mixture of inpatient and outpatient consultations, inpatient care, procedures and occasionally intensive care.

Procedure pricing should also take into account the level of complexity, especially when it is not accurately described by the Clinical Coding and Schedule Development group (CCSD) code. 

Your fees may also want to reflect the impact of some of the other factors I have discussed that arise when treating this patient group. 

Whatever your decision, it is important that this is communicated clearly to the relevant embassy to avoid any misunderstanding or disputes about payment. 


You will need to be prepared for extended payment cycles and allow for this within your practice cash flow. There are taxation impacts to consider, as you may find yourself paying tax to the HM Revenue and Customs on invoices that have still not be paid. This could have a devastating effect on your cash flow if you haven’t planned accordingly.


Even after you have followed all the steps that I have outlined, you will still need a robust system in place to chase for payment that is routinely followed to ensure that your money is collected.

The embassies are always busy, particularly the big four, and it is not uncommon for them to have a backlog of invoices waiting to be paid. The reasons for this vary and Covid has only added to the problem, but a major factor is the sheer volume of patients they deal with.

It is vital that you keep a record of when and how your invoices were sent to the relevant embassy and copies of all supplementary documentation provided in case they get misplaced.  

It is important to monitor your outstanding debt, and should you continue to have issues collecting payment with a particular embassy, then you need to think long and hard about taking on other cases from them until the problem is addressed.

Chasing outstanding fees on a continual basis is the hardest part of this whole process, as most practices are not geared up for this specific aspect. 

This is both time-consuming and requires a specific skill set. It is rare to find a practice which has the time to chase these invoices on a continual basis and maintain adequate records to support this.  

It is crucial to get your practice prepared correctly, preferably before engaging with the embassy sector. 

Otherwise, you could end up carrying out a lot of work and end up waiting a long time for payment or, worse, not getting paid.

Simon Brignall (right) is director of business development at Medical Billing and Collection