Moving from an Insurance or Cash Practice to a CASH-Like Practice

If you have heard, “I can’t afford it,” more than a few times from a patient, you may have, as a knee-jerk reaction, actually believed what you heard and begun to adopt financial policies in your practice to meet everybody’s limited financial status—like let’s make a deal, or unlimited care for a fixed fee, you pay and all your family is free, kids are free! I don’t remember the time I agreed to operate a charity or applied for non-profit status! Do you?

 The cash-like practice is a practice that emphasizes the benefit of care first, and how your patients are going to pay only as a way to receive the care they have decide they need.

It is never the money, or lack thereof; this is the richest country on the planet and people do have money, they just don’t have a priority for spending it on health care. Because of the lack of understanding regarding chiropractic, and not knowing how it will ultimately benefit the person, it is my opinion that people don’t want to pay for care because they don’t believe they will get well anyway. After all, if you review the statistics for medical care, the chances are slim they will get better. So why would someone want to part with their hard earned cash and still not get better? It seems the financial risk is less if a third party springs for it.

I want you to adopt a new policy right now! If someone ever tells you, “I can’t afford it,” rather than believing this excuse, interpret their saying, “I don’t see the value in what you are offering, and how will I benefit from spending my hard earned money for that service”. Then adopt procedures which clearly outline the benefits and value from your service.

Insurance is a crutch and will cause you to practice in ways you may not want to. While chiropractic boasts that we look for the cause not the symptom, insurance is a total symptomatic pain relief model—the exact model we campaign as a profession against. But, in times of our own financial need, it is easy to succumb to the thought that, if the patient had insurance, then they could afford the care and we wouldn’t have to take the time to “sell” the care to them. So we change our model to an insurance-based practice and advise the patient not to worry about anything financial.

You now have a patient that is coming to you with no worry of money, so the visits you recommend are of no other consequence than time. It all seems very good! Two months into care, the first EOB’s return paying ten cents on the dollar, and the next day you receive a request for reports and chart notes stating you will not receive any more of the drastically reduced reimbursements if you don’t comply! (This is not fun!) Additionally, if a patient’s insurance quits or changes, so does the patient. Need and desire for care is based on a third party’s willingness to pay. The patient sees no value and you are now practicing at the whims of someone else’s willingness to pay.


So, you scream, “I hate insurance!!!!!! I am just going to go cash.” This, again, is knee-jerk reaction, and an adoption of yet another emotionally made decision.


There is no place for Emotion in your business decisions.

Emotions are for your personal life and are appropriate in a loving relationship. In business, decisions made from emotion are not appropriate and will almost always end up poorly.


Decisions are made from facts and analysis!

Analyzing facts may take the zest out of your love life, yet it’s critical in your business life. If you are a chiropractor operating a practice, you are in business. Run your business from emotions and you will suffer every up and down associated with the ebb and flow of life. You will become almost manic, as you judge how you feel each day by how many new patients you received, who accepted care, and how many checks arrived in the mail! This is the fast lane to burn out!

The solution is to focus on the “Benefit” you provide your patients, and the consequence to your patients of NOT receiving your service! Financial arrangements are NOT the secret to your success!

A cash practice is a metaphor for the state of mind one must have as a doctor in not only recommending care to a patient, but for the entire package. It’s about how you present yourself, how you educate and motivate a patient, how you demonstrate “Why Chiropractic,” as separate from any other health care discipline, and non-duplicate-able by any other health discipline (i.e., physical therapy is not the same!). These are all small factors which build up to an overall I’m-in-the-right-place or Get-me-out-of-here perspective for those you potentially serve.

With the above well in order, your recommendations must be focused specifi cally on how your service will ultimately benefit the prospective patient. With zero attention on fees, and all attention to benefits of service and consequences of NOT having the service, your personal certainty of your recommendations will be what dictate your case acceptance…not the “deal” you offer.

My favorite phrase is, “Change your thinking; change your life.” So you may find it very helpful to think of all new patients in these terms. A prospective patient enters your office with a real complaint that has been affecting their ability to have a normal life. They had consulted others or even tried other procedures which failed, and now they arrive in your offi ce. What they are looking for is a solution to get their life back…not a deal! I recommend you adopt this mindset; you will then understand how benefit trumps deal every time!

The cash-like practice is a practice that emphasizes the benefit of care first, and how your patients are going to pay only as a way to receive the care they have decided they need. If they have insurance, we will help them and bill the portion that an insurance company will pay. The important thing is that this reimbursement is not payment in full; it is payment toward the recommendation, and the patient will pay the difference. Our fees are our fees, and we will assist them in receiving money from any source to do their part, but we do not change the recommendation by judging their financial means. If they truly need charity, we do a few charity cases a month by case importance, as long as they attest to their total lack of funds.

Now, ask yourself, if a person really had a life altering problem and totally believed you were the solution, do you think—in a society where people rely on labels for status, set goals for more and more adult toys, take lavish vacations, and spend $260 a pair for blue jeans—a little money would actually stop them from doing whatever they believed would get their life back, and increase their health and vitality?

Not on their life!

Dr. Bruce Parker was a pioneer in practice, establishing five offices in his first six years of practice. He has now personally owned thirteen clinics. Through this experience, he developed what he now calls “The Practice Freedom System.” He feels his strongest attribute is communicating the need for lifetime care; his history of patient retention would validate that fact. Dr Parker, president of Bruce Parker Consulting, teaches his “Practice Freedom System.” For more information, visit

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