Should You Go Cash or Insurance?



“The insurance companies are getting harder and harder. They pay less and less. Soon, insurance will not pay for chiropractic care anymore. I think about going cash only. My friend was audited and he had to give $100,000 back to the insurance company.” Have you heard something like this lately? For myself, I have been hearing this for over 20 years. Does this really happen? Yes and no. Yes, because, over the last 20 years, insurance companies have improved their ability to audit chiropractors and have implemented rules to keep control over their spending. Can we really blame them? If it were your company, you would probably manage the same way. And no, because, from a business standpoint, insurance companies can’t really go away. Private insurance companies are selling a product and they have competition. Covering chiropractic care is an added value for the consumers. Insurance consumers are looking to get the most for what they pay, just as we do when we shop around. What insurance carriers want is to avoid insurance fraud at any cost. They want to make sure doctors provide all the care they claim and make sure chiropractic care is really what the patient needs. Insurance control will keep improving in the future.

As an example, one of the requirements for a software being certified and qualified for the stimulus package is to have an audit log. This means that any change you will make in your computer system will be recorded. This may trigger alarms to the auditors. You may be asked questions like: Why have you added this information to this patient file? Why have you changed or added this to the SOAP note? The new log file for certified software may be just another step up for auditing. Not only they can see what was changed or added, but they can easily find out when the change was made. So, if you ever buy a certified software in order to get some stimulus dollars, you will have to keep all your patient files very accurate. But this is fine. You should do this anyway, stimulus or not. You do your work right, you will get paid right. If you document everything you do correctly during each visit, provide the necessary number of treatments but not more, show a health improvement in your documentation and only claim services which the insurance covers, you are all set. You will get paid easily.

Does this really happen in real life? Absolutely. I know hundreds and hundreds of chiropractors who are very successful with insurance. They just do it the right way and they have no problem with any insurance carriers. I am not saying “no” to go cash, if you want to. I know hundreds of very successful chiropractors who work with cash patients only. What I am saying here is going cash is not necessarily a solution, if you are having a hard time with insurance claims.

The solution is to take a step back and get well organized to manage insurance. You have tools available to make your insurance management very easy. Some management software have cool billing and documentation automated features. After you enter detailed SOAP notes (pressing only a few buttons), the patient and insurance billing will be generated automatically and accurately. Copay, deductible, maximum will all be adjusted automatically. So, you have accurate real time SOAP documentation and insurance billing at the same time. Auditors are welcome to your office at any time.

Now, some E.H.R. software providers will provide you full insurance claim support. Knowing you and your staff have an instant and constant support for your insurance claims is a huge pain relief. And guess what? You will be back fully focused on what is really important for you: providing great care to all patients; not on being scared of auditors or thinking why you have not been paid, etc. One thing we tend to forget is that accurate SOAP documentation is not only for insurance auditors. It is also for yourself, for lawyers, for your chiropractic boards, etc. Accurate notes are required at all times, no matter if you claim insurance for your patients or if you operate your office mostly in cash. Managing insurance or going cash with your patients should be directly related to your personality. In both cases, it is difficult to talk health and money at the same time to a patient. You have two bad and one good news for the patient. The bad news is the patient has an important health problem and there is a bunch of money needed to fix it and the good news is that you can give him back his health.

:quoteright_open:Accurate notes are required at all times, no matter if you claim insurance for your patients or if you operate your office mostly in cash.:quoteright_close:

This is when your personality for insurance or cash comes into play. How easy is it for you to say to the patient, “Here we do not accept insurance. You pay us at every visit and you have to claim your personal insurance yourself.” Or, it could be, “Here, we accept insurance. You will be responsible for an insurance deductible, a copay amount and, from there, we will be taking care of your insurance.” For the financial part of your operation, there is no magic solution. Both insurance management or cash office can work very well for you. It is up to you to have a plan in place, use the tools and support available and do it the right way. And, truly, in my very personal opinion, in 20 years from now, we will still hear, “The insurance companies are getting harder and harder. They pay less and less….”


Claude Cote is an expert in EHR systems, insurance bill- ingandchiropracticclinicmanagementfor22years. Hehas installed EHR system in 17 countries over 5 continents and nationwide in USA. He is the President and Founder of Plati- num System C.R. Corp ( For comments or questions, please email to [email protected].

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