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A chiropractor will stop accepting insurance and start charging a flat $20 a visit instead.

The biggest pain in chiropractor Ronald Mack's life isn't a sore back. It's dealing with insurance companies.

"Everybody knows getting a real person on the phone is almost impossible," Mack, who runs Mariner Chiropractic, said. "We'd call a company and say, 'We submitted this bill,' or 'We haven't been reimbursed,' and we'd get 'Press 1 for this,' or 'Please wait. You're on hold.'"

After 30 years, Mack finally has gotten fed up with the insurance headache.

So starting July 1, his Spring Hill practice will no longer accept insurance. Instead, he'll charge a $20 flat rate for each visit.

Mack is joining a growing trend of cash-only chiropractic offices, which are making a comeback nationwide.

A study compiled by Chiropractic Economics magazine and cited by the U.S. Bureau of Labor Statistics shows that the percentage of cash-only practices steadily dropped from about 21 percent in 2006 to roughly half that in 2009.

But this year's numbers have doubled again, bouncing back to 21.5 percent - the highest percentage in six years.

"Fifteen years ago, insurance paid more and paid easier, and cash wasn't the way to go," said Ryan Daley, the assistant editor of Chiropractic Economics. "That's definitely changed."

Although not all insurance policies cover chiropractic services or other specialities, many do.

Daley said chiropractors have taken a hard look at the profession's high administrative cost, much of which comes from billing insurance agencies.

"The question is: Is it worth having a staff member on payroll to deal with billing and insurance, or do you just want to risk it and go cash only?" Daley said.

Mack decided to risk it.

Of a sampling of 11 Hernando County chiropractors contacted, Mack is the only one who's switching to cash-only payment.

He and his wife, Greta, crunched the numbers.

Each day, he needs to make about $1,000 to stay comfortable and keep the business afloat.

He estimates he can see roughly 50 patients a day at his Chalmer Street office.

After that, it was simple math: 1,000 divided by 50 is $20 each.

Yes, 50 sounds like a lot, Mack said. But he pointed out that chiropractic visits take less time than visits to other types of specialists - about 10 minutes each.

"The initial office visit is the time consumer, and any visit after that is pretty brief," Mack said.

Mack and office manager Dee Dawson, who has worked at Mariner Chiropractic for 18 years, both said that having 50 to 60 patients a day was normal before the economy tanked a few years back.

"And the reality is, I'd rather be busier than not," Mack said. "I'm happiest when I'm practicing."

About 75 percent of Mack's patients are on Medicare, Dawson said, which covers 80 cents of every dollar.

Dawson said Medicare patients pay about $5 a visit, and although most will be able to shell out an extra $15 per visit, $20 "might not be as doable" for those on tighter budgets.

But many insurance companies already have a $25 co-pay for specialty services, Mack said, so $20 will be cheaper for many of his customers.

Agustin Vazquez, 63, is on Medicare and sees Mack regularly for pain in his neck and upper back. He hadn't heard of the insurance change, but he said he won't stop coming in when the office switches over.

"That's real nice," Vazquez said when he heard of what Mack is doing. "None of my insurance wants to cover this."

It can be a hassle to get many insurance companies to cover chiropractic visits.

"Especially Medicare?" he asked Mack as they headed into his office.

"Especially Medicare," Mack replied.

He treated Vazquez in less than 10 minutes.

Laura Nelson can be reached at or at (352) 848-1432.