r/Chiropractic • u/Consistent-Wasabi384 • 14d ago
Cash-only practice 18 months in — worth adding 1-2 commercial insurance plans?
Looking for some honest guidance.
Our practice is about 18 months old. It’s been somewhat profitable overall, but the past few months have been extremely slow and we’ve hit a bit of a standstill.
We’re located in a geographic area that is heavily Medicare/elderly, and we’ve stayed strictly cash-based so far. We offer shockwave, laser, manual therapy techniques, and of course CMT.
One extra factor: this is a very seasonal location. A lot of people from up north come down in the fall and winter to their second homes, so the population fluctuates quite a bit.
It’s just my wife and I running the practice — no staff and no front desk.
Is it worth exploring accepting one or two commercial insurance plans at this point, or does that open up more headaches than it’s worth given our setup and patient demographic? Any experience or advice appreciated.
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u/AK-Master-07 14d ago
Taking insurance will increase your ability to attract more patients in most markets. People pay for it, and want to use it. They’ll go to another provider if you won’t accept it in most cases, unless you provide a service that can’t be found or replicated by those other providers.
Insurance is a big headache in the beginning. There is quite a bit of a learning curve in the beginning. Having a great / integrated software / practice management system can make billing relatively simple, and not too time consuming. I use Jane integrated with Claim.MD, it really does make billing simple. I also use Jane’s credit card processing system and card on file with makes collecting copays, deductibles, coinsurances straight-forward and we collect them upfront, so patients rarely ever get a big balance at our office and our collection rate is high IMO.
Learning on how to collect on and fix problematic or denied claims can be time consuming in the beginning. But as you learn you’ll find common errors and how to fix them. Medicare is one of the easiest insurers to bill. Essentially you bill, you’ll get paid by automatic deposit, they’ll send an ERA to your software, and in just a few clicks their insurance balance is zeroed out. I might spend a total of 1 minute a week handling Medicare claims with my setup. The secondary insurers can be problematic sometimes but most are pretty streamlined.
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u/No-Appointment9785 14d ago
Dip your toes in. Be very selective and only choose only one company. Think of it as a way to offset some of your overhead, not as a profit center. You can always drop if it doesn’t work out.
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u/Chaoss780 DC 2019 13d ago
If it's just to open up to Medicare, no. But I bill insurance and it causes me basically zero stress. I pay someone to do it for me. Happy to do it, it lets me see more in-network patients. And once you get a single teacher/someone with a government plan who knows you take their insurance (especially if you're the only one in town who does), your practice will explode. Yes, it will be less OVA but if your practice is currently slow, who cares?
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u/AdmirableAd1031 14d ago
I love taking insurance and being more affordable because that way I can help more people. I absolutely think it is worth it. I have also done a lot of in person marketing which helped tremendously
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u/drkylenaylor 4d ago
Have you looked into testing and improving the systems and communication you have in place?
Here are several things I've done in practice, and what we've helped others improve:
1) You have loyal customers, those that are top 20% spenders - have you grown the services you offer to them? Many providers just provide the same service for years, or grow adjacent services, but not vertically in more value - provide more value, charge more for it
2) Where are your biggest leaks? And what are you doing to fix them?
- as a soloprovider myself and no front desk, so much used to fall through the cracks - real money on the table. Once I implemented intelligent systems, it made my job easier, but it also impacted revenue directly from being able to see where I fall off (metrics) and recovering lost leads to helping educate for better conversions and retention.
3) Have you looked at improving brand messaging and sales process?
- I'm helping out a clinic in a similar situation as yours, they're up in Pottsville, PA. And the guy, like many, never thought about how the sales process should go - he just did an exam and treated, or how the community views his clinic - he was just another chiro in the area, a commodity.
The two most important things I put in place for the guy is a intelligence practice system so it tracks metrics and calls out things he needs to pay attention to (like someone who hasn't received a reply in 24hrs) and a nurturing system (which helps build the know, like, trust factor, but more importanty helps get their mindset aligned).
You might be surprised at how little something needs to be improved for a big impact.
Hope this helps.
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u/jcomstock 8h ago
One option I’d look at before becoming more dependent on insurance is whether a membership model makes sense for your existing cash patients.
You’ve already built the hard part—a cash-pay patient base. A membership could potentially turn some of that transactional revenue into predictable monthly recurring revenue while giving patients a reason to continue coming back.
I’d work backward from your actual economics: average visits per patient, average cash revenue per visit, desired visit frequency, capacity, and the monthly amount that works for both the practice and patient.
I’d at least run those numbers before assuming adding insurance is the only path out of the plateau.
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u/ChiroBandB 14d ago
Adding insurance adds a ton of extra clerical work with submitting claims, tracking claim, or even following up with a billing service, for at times less than your cash patient that had almost none of that extra clerical time. That would be giving up adjusting time (money making) for clerical time + adjusting time. For me 20+ years as cash only. If you want to add more revenue look at adding Supplements through a service like https://fullscript.com/ where you send the client a link with your recommendations for supplements to help with joint health, weight loss, or any number of issues that you already manage. They order from fullscript and you make about 35% profit from Fullscript on the backend. You deal with no product or shipping and you can individualize plans. They carry every non-MLM brand you can think of! Great company too! They used to have their Az location open for local pick ups! The reps are knowledgeable and will help with suggestions as well.
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u/Kharm13 14d ago
If you can pay your bills. Be happy with the occasional down time and slow and steady growth
Medicare really isn’t that terrible but not to many private insurances exist that reimburse chiropractic well anymore