Response by a DC about their transition to a cash practice in 2000 If you have questions send a message to: Bruce@ClarkLink.com This message is in response to your inquiry to Dr. Joel Margolies about cash practices. My wife graduated from Life University in the summer of1999. Because we had planned ahead, we were able to immediately start our own practice. Initially, we accepted every type of payer you can imagine. I even used her being a woman doctor to reverse HMO rejections for entry into plans. The problems we experienced with insurance are many. They want you to justify care without payment for time spent granting their requests. We can't offer a Time of Service discount if a customer's insurance doesn't subsequently pay, so the customer feels cheated. Medicaid paid very little ($15), but always paid. Medicare was the worst. We never received any money for services provided for the first six months. I don't believe it was a mistake because most insurance paid and we attracted a lot of patients which helped us grow. One local chiropractor and the president of our state association told me if they were starting today that they would go all cash. When we lost a patient because their insurance denied and they had to pay more than a cash (TOS) patient did, I knew it was time for a change. We sent letters to all the existing patients informing them of the new policy. We lost some, but gained back the volume by promoting our new pricing. We charge $27 for a comprehensive office visit. This includes exam, chiropractic adjustments, extremity adjustments, manual therapy, TENS unit, consultations, and lab work. X-rays are not included, but ordered through a nearby lab so that patients can use their insurance for these. Most patients only need a couple of services per visit. We know we are too low (our patients tell us), but we do this on purpose to gain market share. We still make enough to fully fund our retirement plan and pay off the house within seven years. The downside is that a worker's comp patient pays $27 in advance, but we would get $60 if we gambled on the claim. In 2002, we expect to go to $35.