J.T. Anderson , DC
There’s a moment in every chiropractor’s career when you ask yourself: Is this really why I got into this field? For me, that moment came at 7:00 p.m. on a Tuesday, long after the last patient had left. I was surrounded by folders, billing codes and endless stacks of insurance paperwork. My back hurt; my eyes were dry; my head was pounding – not from adjusting too many patients, but from dealing with insurance hell.
A denial here. A coding issue there. A rejection for “lack of medical necessity” – on a patient with visible disc compression. I had just gotten off the phone with an insurance rep who’d cheerfully informed me that my claim “might” be processed “in six to eight weeks.”
That was the night I decided: This is not sustainable. There has to be a better way.
The Awakening: Discovering the Cash-Based Model
In the weeks that followed, I dove headfirst into research. I spoke with colleagues, attended seminars and listened to business coaches who specialized in helping healthcare professionals cut the cord from insurance dependency. One phrase kept coming up over and over again: cash-based practice.
At first, the idea made me nervous. Would patients balk at paying out of pocket? Would I lose business overnight? Would I come across as greedy or disconnected from the real-world financial struggles many people face?
But the deeper I looked, the more I realized this model wasn’t about money; it was about freedom, clarity and better care.
Why Insurance Is Draining Your Practice (and Your Soul)
If you’re running an insurance-based practice, you already know the pain:
1. Administrative Overload. For every hour you spend with patients, you spend another hour doing admin. Coding. Filing. Appealing denied claims. Chasing unpaid invoices. Managing billing staff.
You didn’t go to chiropractic school to become a paper-pusher or an insurance interpreter. You went to help people.
2. Delayed (or Denied) Payments. Insurance companies are notorious for delays. You might not see the money for weeks – and sometimes months – after a service is rendered. And even then, there’s no guarantee you’ll be paid what you billed. Arbitrary adjustments, partial payments and underpayments are the norm.
3. Compromised Care. Perhaps the most frustrating of all is when your care is limited by what insurance will cover – not what the patient actually needs. You’re forced to undertreat, rush sessions or stop therapy too soon because the “maximum visits” have been reached.
It’s not just bad business. It’s bad medicine.
The Cash-Based Revolution: Clarity, Efficiency and Control
Switching to a cash-based model was the most important decision I’ve made in my career – and here’s what changed.
1. Clean, Simple Transactions. No more coding, no more CPT modifiers, no more EOB statements. My patient pays. I provide care. We’re done.
That alone eliminated hours of administrative work per week. I was able to cut back on front-desk staffing, reduce overhead, and reinvest that time into growing my business and spending more time with patients.
2. Predictable Income. When I was billing insurance, I never knew exactly what I’d be paid or when the money would show up.
Now? Payments are made at the time of service. I can plan my business around actual numbers, not projections and unpaid claims. Cash means stability. It means freedom from the feast-or-famine cycle so many insurance-dependent practices endure.
3. Stronger Patient Relationships. You might think patients resist paying out of pocket, but the truth is, people are happy to pay for value; especially when they feel seen, heard and well cared for.
In a cash-based model, I’m not racing through 10-minute appointments to hit volume. I’m spending meaningful time with each patient. They feel the difference – and they tell their friends.
The irony? My retention rate actually improved when I stopped taking insurance.
4. Total Clinical Freedom. I no longer have to worry about whether a treatment will “qualify” under an insurance plan. I do what’s right, not what’s covered.
Want to do soft-tissue work, rehab exercises, laser therapy, or extended sessions? You can – and you don’t need to ask anyone’s permission. You can practice real chiropractic care, not insurance chiropractic care.
Addressing the Elephant in the Room: Affordability
Yes, going cash-based does require a shift in how you position your services. But it’s not about excluding people – it’s about communicating value.
When people understand you’re helping them avoid injury, surgery, long-term medication and recurring pain, they see the price tag differently. Here’s what helped me:
- Offering package deals (e.g., 10 visits for a discounted rate)
- Providing a superbill for patients who want to submit to their insurance themselves
- Focusing marketing on long-term health benefits, not just short-term pain relief
And here’s the truth: People do have money. They just need to believe you’re worth it.
What I Gained (That No Insurance Company Could Ever Offer)
Time. I no longer spend evenings doing paperwork. I go home earlier. I sleep better. I spend weekends with my family – not catching up on admin.
Profit. My margins are better. Even if I see slightly fewer patients per week, my revenue is higher – and I keep more of it.
Peace of Mind. No more audits. No more clawbacks. No more anxiety over reimbursement rates being cut again.
Passion. I actually love practicing again. Every patient gets the best of me – and they give it back.
Your Turn: Building a Practice That Works for You
If you’re stuck in the insurance grind, here’s my advice:
- Start Small. Try converting one service or patient segment to cash. Build from there.
- Educate Your Patients. Show them the value. Give them testimonials. Create handouts or videos explaining the benefits of paying directly.
- Design a Compelling Brand. Don’t just be “the chiropractor down the road.” Be the wellness expert, the performance coach, the injury-prevention specialist. Package your expertise.
- Get Help. Hire a coach or join a mastermind. Learn from people who’ve done it. (You’ve already taken a big first step by reading this article.)
You became a chiropractor to serve people, not an insurance company. You deserve to run a business that aligns with your values, supports your family and lights you up.
Cash-based care isn’t just a pricing model – it’s a philosophy rooted in freedom, trust and respect for your patients and for yourself. And once you make the switch? You’ll never look back.
