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The Wellness Plan That Replaced My Insurance Billing Nightmare

By Dr. Marcus Webb, DC — Austin, TX

I opened my chiropractic practice in 2017 fresh out of school. I enrolled in insurance networks because that’s what everyone told me to do. I signed up with four major carriers in the Austin area.

Two years in, I had a thriving patient roster and a billing operation that was eating my practice alive.

Between the four carriers, I was dealing with 14 different fee schedules, varying prior auth requirements for x-rays, routine denials on active care after a certain visit threshold, and reimbursement rates ranging from $28 to $61 per adjustment depending on the code and the carrier. My biller spent 30–40% of her time on appeals. We wrote off approximately $2,100/month in denied claims that weren’t worth appealing.

Average net revenue per visit after write-offs and billing costs: $44.

In 2019 I added a cash-pay wellness plan and started transitioning out of networks. By 2021 I was 100% cash-pay and my net revenue per visit was $78. Same adjustment, twice the revenue.

The Cash-Pay Chiropractic Invoice

Cash-pay chiropractic billing is simple: price published, collected at checkout, superbill provided.

Chiropractic Session — [Patient Name] — [Date]:

Superbill generated at checkout. Patient submits to their insurance or HSA/FSA as applicable.

Common Chiropractic CPT Codes

Wellness Plan Membership Invoices

Invoice Flow app invoice editor of a cash-pay chiropractor — 12 adjustments, therapy sessions, initial exam and an enrollment discount with NPI and HSA eligibility documented
The whole 12-week plan on one document — NPI on record, HSA-ready, first installment in.

The wellness plan was the structural change that stabilized my practice.

Instead of per-visit billing that creates an incentive to bill for frequency, a monthly wellness plan charges a flat monthly rate for a set number of visits and services. Patients commit for 3, 6, or 12 months. Revenue is predictable. Cash flow is stable.

Wellness Plan Membership — [Patient Name] — [Start Date]:

Wellness Plan Tiers

Build a separate InvoiceFlow template for each tier. At enrollment, enter patient name, select plan — monthly rate, billing date, and terms auto-populate. InvoiceFlow generates and sends the invoice every month automatically.

Family Wellness Plans

Family plans are the highest-retention product in chiropractic. A family on a plan renews at higher rates than individuals.

Family Wellness Plan — [Primary Account Holder] — [Start Date]:

Corporate Wellness Contracts

Invoice Flow app recurring invoices of a chiropractic practice — monthly wellness and maintenance plans plus a corporate ergonomics program
Wellness plans and the corporate program bill themselves — the practice scales, the paperwork doesn't.

Several large Austin employers had office complexes near my practice. I approached three of them about on-site chiropractic days — coming to their office one day per week for employee wellness sessions.

Corporate Wellness Services — [Company Name] — [Month Year]:

Billing Period: [Month Year]

Remit to: Dr. Marcus Webb, DC | EIN: [XX-XXXXXXX] PO Number: [PO-####] Payment Terms: Net-30 W-9 on file

Two of the three companies said yes. Combined, they added approximately $5,200/month in predictable net-30 revenue.

New Patient Exam and X-Ray Packages

New patients require a comprehensive exam before beginning care. I package the exam with x-rays when indicated.

New Patient Exam Package — [Patient Name] — [Date]:

The new patient package is a fixed price regardless of how many x-ray views are taken. Patients understand exactly what they’re paying upfront. No surprise billing.

Five Years Cash-Pay

Current monthly revenue:

The insurance billing system was paying me $44/visit net. Cash-pay wellness plans pay $78+/visit equivalent — and most visits are pre-funded by the monthly membership.

Download InvoiceFlow. Build wellness plan templates for each tier with monthly auto-billing. Add superbill documentation to your per-visit template. Set corporate invoices with EIN and net-30. The patient who would have been lost in insurance authorizations is now on a wellness plan whose invoice generates and sends every month automatically.

Dr. Marcus Webb is a Doctor of Chiropractic in Austin, Texas, operating a cash-pay chiropractic practice serving individual wellness plan members, families, and corporate employer wellness accounts.