Risk Q&A

Payment Issues in Chiropractic Practices


At the time of an appointment, or as a condition of scheduling an appointment, can a chiropractic practice require a patient to pay his/her portion of an expected deductible, copayment, or other charge not covered by insurance? If the patient does not pay, can the appointment be cancelled or rescheduled upon receipt of the patient’s payment?


Patients are obligated to pay for services they receive from chiropractic practices, and chiropractors are obligated to provide a reasonable standard of care for existing patients and patients for whom contracts or regulations trigger an obligation.

Balancing business and chiropractic obligations requires a fact-specific approach. A chiropractic practice’s payment expectations and consequences for nonpayment should be included in written policies and procedures as well as patient informational materials.

Before making scheduling decisions (e.g., cancellation or rescheduling) based on a patient’s ability to pay, the chiropractor should confirm that the scheduling decision will not adversely affect the patient’s health. Additionally, healthcare administrators should determine whether regulations or contractual agreements affect the decision.

Fact variations may include the following related to payment at time of service:

  • Symptoms or ongoing care management. For existing patients — or prospective patients for whom contracts or regulations trigger an obligation to treat — schedule an appointment based on the patient’s need. Or, staff should consult with a chiropractor to determine whether the appointment can be rescheduled or whether a referral is appropriate.
  • Outstanding unpaid balances. If the chiropractors in the practice agree that a patient should be discharged from the practice for an outstanding unpaid balance, then the patient should be informed and given a deadline to pay the balance to avoid discharge. The practice should provide the patient with adequate written notice of this possible termination from the practice to allow him/her sufficient time to pay the unpaid balance or secure another chiropractor. Additionally, this action should be documented in the patient’s health record.


If a scheduling decision requires a chiropractor’s evaluation, then the chiropractor should document his/her assessment and scheduling recommendations in the patient’s health record. For example, the chiropractor might document that because the patient is stable, rescheduling the appointment will not adversely affect his/her health.


This document should not be construed as medical or legal advice. Because the facts applicable to your situation may vary, or the laws applicable in your jurisdiction may differ, please contact your attorney or other professional advisors if you have any questions related to your legal or medical obligations or rights, state or federal laws, contract interpretation, or other legal questions. 

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