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Chiropractor to go cash-only

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By Christian Livermore
Times Herald-Record
Posted: April 06, 2009 – 2:00 AM

TOWN OF WALLKILL — A local chiropractor fed up with the hassle and underpayment by insurance companies is switching to a cash-only practice.

Dr. Peter Holst said insurance companies are paying less of the cost of chiropractic visits, making patients pay more and drowning doctors in red tape.

Some require a preliminary exam to document the need for treatment, but won’t pay for it. Some deny payment for inexplicable reasons. One allows a $29 fee for a basic visit, but sets the patient’s co-pay at $40. Insurance company payment: Zero.

“I hate the thought that me cutting out insurance might impact my patients and the trust and confidence they have in me, so any fee that we establish will be in line and close to any co-pays they are already paying,” Holst said. “Why do I have to waste my time dealing with insurance companies when they’re not paying for anything anyway?”

He plans to make the switch in the next year, and is still figuring out what his fees will be.

Holst is one of what seems to be a growing number of doctors who have thrown up their hands with insurance companies.

“We have heard anecdotal evidence of a rise in the number of cash-only practices,” said Angela Kargus, spokesperson for the American Chiropractic Association.

It’s hard to pin down exactly how many cash-only doctors there are nationwide, but an annual survey by the trade magazine Chiropractic Economics showed that in 2008, 8 percent of survey respondents were cash-only, compared with 7 percent in 2007. But the number has seesawed up and down: 21.1 percent in 2006, 11.7 percent in 2005, and 6.4 percent in 2004.

Other doctors have switched to “boutique” or “concierge” practices, where patients get unlimited visits in exchange for an annual fee.

Some dentists are making the switch, as well.

Town of Wallkill dentist Dr. Donato Napoletano still accepts insurance, but dropped all managed care contracts about 10 years ago, fed up with the lower fees the insurance companies paid through contracts, fees that barely covered his expenses.

“I could not spend sufficient time with patients because I had to get a certain number of patients in to meet my expenses,” he said. “I just reached a point where I said, this is not why I became a dentist.”

By |April 6, 2009|News|7 Comments

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Dr Wiens created the very first chiropractic information page on the web in Nov 1994. In 1995 he joined as chief designer. He lives in Canada.


  1. stevev April 7, 2009 at 8:17 am

    Two thoughts come to mind every time I see or hear of Doc’s going all cash.

    First, that is how DC’s made a very good living before insurance inclusion back in the early 60’s and we’ve progressed a very long way in providing services since then. No reason we can’t make a good living at a reasonable fee to our patients again.

    Second, it empowers the DOCTOR to get back to being the one, with the patient, to be the decision makers as to what is the needed care for each individual patient, based on Sx and Tx response. As we all have seen day in and day out, each patient progresses differently at their body’s own rate depending upon ALL the factors unique in that patient’s life. I have never had a patient (who has been part of the small percentage that may need that bit of extra care) that has been satisfied that all the research says they should be “all better” yet they are still in pain!

    Seems they didn’t participate in the research!

  2. Obie Bendix April 7, 2009 at 9:17 am

    It’s a wonderful system where 30% of the health care dollar is spent on finding reasons to deny people the care they need.

    My concern is only if all-cash practitioners refuse to see patients who can’t afford treatment. Enough of these practitioner types will ensure that many persons who otherwise might benefit from care, never will.

  3. stevev April 8, 2009 at 7:19 am


    This is already happening and it has only created a ‘niche’ which is being filled by some. I have a very good friend that is not only cash based practice but also targets or “specializes” (if that’s what we can call it) in care for the uninsured/under-insured and does most all his advertising on spanish radio stations. He speaks fluent spanish (self taught in 6-8 months). His clinic is walk-in/no appointments only. He almost always has about a 2 hour wait to be seen in his office. He has one other DC in the clinic with him.

    Uninsured/under-insured clinics will pop up like weeds should your concern become an issue. Simple demand creating the supply.

  4. La Crosse Dentist April 8, 2009 at 5:01 pm

    Well I bet he’s going to get a huge drop in patients if he does go cash-only.

  5. Seth Gross, DC April 29, 2009 at 5:50 am

    I went “cash” two years ago for those that are under or non insured. Set up a pre-paid “Corrective Care” schedule (3-12 months). After correction care set up on a pre-paid “Wellness Care” schedule (1-4x/month) also pre-paid. paying up front eliminates confusion and stress for all involved.

  6. Rich Casabona August 10, 2009 at 10:15 pm

    Hey Dr. Pete way to go. Be free and enjoy life.

    Dr. Rich

  7. Ken Whidden September 7, 2009 at 9:56 pm

    It will be interesting to see how the health care reform treats us and whether we may all be cash only. We may be better off in the long run without insurance hassles.

    Ken Whidden
    Emerald Coast Chiropractic

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