Refund requests are an unavoidable part of running a chiropractic practice. Whether a patient is unhappy with their care, believes an adjustment caused harm, or simply changes their mind, these situations must be handled carefully to avoid escalation.
While chiropractors are not legally obligated to issue refunds in most cases, there are times when doing so is the best business decision to protect the practice. I always coach doctors to approach these decisions through a business lens rather than reacting emotionally, as it helps them make the best decision for their practice.
The key? Understand your rights, have clear policies, be proactive in communication, set realistic expectations, and know when issuing a refund is the best business decision.
Common Reasons Patients Request Refunds
Refund requests vary, but common reasons include the following:
- Lack of results – The patient didn’t experience the relief they expected.
- Symptoms worsened – They feel their condition deteriorated after treatment.
- Went to another doctor – A second provider gave conflicting advice.
- Changed their mind – They decided not to continue care.
- Financial hardship – They can no longer afford treatment.
- Unused prepayments – They prepaid for visits, but didn’t use them all.
Some refund requests are simple to resolve. If a patient prepaid for visits, but stopped coming, referring to a clear financial agreement can clarify expectations. However, some state boards take the position that refunds should be handled in a standardized way and have consumer protections, like fitness center contracts.
For example, if a patient signed up for 20 visits of care, but only came in for three, some boards have ruled they are responsible only for the three-visit cost, at the discounted package rate. Chiropractors should be aware that state board decisions may override financial agreements.
Real-World Example: A Family Refund Request
A chiropractor recently called for guidance after dealing with a refund request involving an entire family. The doctor had signed up a husband, wife and their college-aged daughter for prepayment care plans. Everything was going well until the wife complained of ankle pain following an adjustment. She sought treatment from an orthopedic specialist and began physical therapy.
Shortly after, she stopped coming in, and both her husband and daughter followed suit, requesting refunds for their unused visits.
The chiropractor was willing to refund their plans, but wanted to ensure that doing so would not be perceived as an admission of guilt. The best approach in this case was to process the refunds as a gesture of goodwill and move on. It’s critical you document the conversations had, the patient’s request, and that you refunded as a gesture of goodwill.
Requests Related to Injury Claims
Refund requests related to claims of injury should be handled even more cautiously. If a patient alleges that care caused harm, the chiropractor should immediately consult their malpractice carrier before making any decisions. Issuing a refund without documentation may help the situation go away, but if anything comes of it down the line, your documentation is what protects you. An outright denial can escalate the situation.
If a refund is offered, as mentioned before, it should be clearly documented as a patient-requested resolution and a gesture of goodwill.
Why Sending a Patient to Collections Is Almost Always a Bad Idea
In most cases, sending a patient to collections does more harm than good. A patient with an unpaid balance may retaliate by filing a board complaint, disputing the charge, leaving negative reviews, or filing a malpractice lawsuit. What starts as a minor billing issue can spiral into a costly problem.
A particularly extreme example involved a chiropractor who had an $80 unpaid balance from a patient. After two years, the doctor sent the account to collections. Unbeknownst to them, the patient had passed away and their family was involved in a wrongful-death lawsuit against multiple other providers who treated him.
Upon receiving the collections notice, the family discovered that the patient had been under the chiropractor’s care and added him to the lawsuit. This case underscores the unintended risks of collections and why chiropractors should think carefully before pursuing small balances.
Best Practices to Avoid Escalation
Instead of collections, consider these strategies to avoid escalation:
- Be proactive about balances – Monitor accounts and avoid letting overdue balances get out of control.
- Offer flexible payment plans – Helping patients stay on track prevents disputes.
- Clearly communicate refund and cancellation policies – Setting expectations upfront reduces confusion later.
- Pick up the phone before escalating – A direct conversation can often resolve issues before they turn into complaints.
Final Thoughts
Refund requests are part of practice management, and while chiropractors are not obligated to issue them in most cases, sometimes it’s the best course of action.
When faced with a request, ask yourself: Is the amount in question worth the potential headache of a complaint, legal action or reputational damage? If you choose to refund, do not charge an administrative fee; give them their money back. And finally, we get asked often about using a release – while it can be useful in some cases, it’s not a good idea when the patient is a senior or we’re talking a low dollar amount.
By treating refund decisions as business matters rather than emotional reactions, chiropractors can protect both their practice and peace of mind. It’s always advised to consult your malpractice carrier and make decisions that serve your practice’s long-term best interests while also minimizing your exposure when navigating refund requests.
