Should I Go All Cash?

Dr. Tory Robson

Dr. Tory Robson

Chiropractic Practice Success Consultant

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You basically deal with five different types of patients: Medicare, personal injury, work injury, regular insurance patients, and cash patients.

We also have people who’ve been in a car accident and think they have coverage but they don’t. Those with a work injury who think they have coverage and they don’t. Lastly, we have those who think they have some insurance but they don’t.

Your ability to get all of them to trust you and start care is part of the art of being a chiropractor. As a chiropractor, it matters what you say and how well you say it. What you do and how well you do it. Then there is your image. All three must be on point for maximum success.

You are really on top of your game if you can convince someone who has 100% coverage elsewhere to still see you and pay out of pocket. This is quite difficult to do and rarely occurs despite what anybody tells you. When it does occur you will usually find the chiro has very low fees. Which is another problem we can talk about in a later post.

Some doctors say: “Tory, I want to be all cash.”

I ask a few questions:

Do you understand that you cannot touch any person over the age of 65 who has a Medicare card and not send a claim into Medicare? There’s no such thing as opting out of Medicare.

(Chiropractors assume they know how Medicare works. They think they can do whatever they want. In reality there are rules. You must do the research. We have the latest information on Medicare as well as experts to contact about all Medicare guidelines.)

If you have a cash patient who is 64 years old who turns 65, and now has Medicare coverage. You’re going to tell them they have to continue to pay you cash?

Let’s say you have a great cash patient. They get into a collision and now have 100% coverage for all of their care. You’re going to tell them they still have to pay you out of their pocket?

Say goodbye to these patients.

Let’s say you have a patient who is paying cash and they get a job with a union that pays for 20 chiropractic visits a year, you’re going to try to convince them to still pay you cash.

Insurance is so easy in chiropractic. The Pro chiropractor is an expert at Medicare, an expert with personal injury in their state, an expert with work injuries in their state, an expert with all local insurance, and an expert with cash.

That means you are an expert with every single person that walks in the door. Much better than being too lazy to learn how to do this and instead trying to shoehorn everybody into a cash plan.  

Now, I don’t like insurance and I’m not promoting insurance. I realize some of the pains that come with insurance, but my responsibility is to take the best care of my patients and be as attractive to as many patients in my community as possible.

I do coach chiropractors that are heavily cash but still send in for car injuries and Medicare. This is absolutely fine.

You only know your state. In your area, insurance may be crummy and you have no choice but to be mostly cash. In other states, insurance still works well. In some states, they have little personal injury coverage, other states a DC will average over $4500 per case.

So we must figure out what is best for you in your area. A post like this can only speak in generalities, which mean nothing for YOU! We must engineer YOUR plan. You may have local HMOs, PPO’s, Networks that are so big you cannot get in, networks you want to get out of, PI rules, and Medicare that works a certain way. We need a call to get your codes, fees, billing, and care plans all in perfect order for max success.

Again, you want to become an expert in ALL 5 types of patients.

I started out in Wisconsin. There were three big HMOs that I was never going to get into with 90% coverage for their members. I had no choice but to run basically a cash practice with a little bit of Medicare and some PI. When I moved to Minnesota, I was shocked at how different it was. There are more insurance benefits in Minnesota, so insurance became a focus.

Moving 4 hours away my collections more than doubled. I went from $400,000 in Wisconsin all cash to $1,000,000 in Minnesota at the same volume!

There are better states to practice in, no doubt about it. And I know which ones they are. For example, in Florida you can see 200 a week and collect more than any DC in another state who is working like crazy to see 500 a week. Take your pick.

The area you’re in will determine how much cash emphasis you have. You are truly out to take the best care of your people and run the most successful business you can.

Either way, the pro chiropractor is an expert in understanding how Medicare works in their area. You’re an expert with personal injury in your area. You’re an expert with how work injuries are handled in your area. You’re an expert with any insurance companies in your area, and you are certainly an expert with cash and family plans.

Be an expert at everything related to making it possible for a person to come in and get started under care.

At WINNERSEDGE we have the wording for every scenario and patient you will face, and the best way to get them to start. Or at least maintain your power if they do not.

We have the ultimate initial plans, re-sign process, and wellness plans.

Who collects the most? Chiropractors who collect the most are the ones that accept all types of people and are experts in all types of cases.

Some chiropractors want a very simple practice of pure chiropractic, mostly cash, with one CA in 700 sq ft. This is absolutely fine. If you tell me the kind of practice you want, I can coach you to the highest level of success with that style of practice.

If you want to build a huge PI following, absolutely fine. I can do this also because I’ve done it myself.

Let’s get your practice model dialed in perfectly so you can have the most fun in the most graceful and profitable way possible!

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