The Great Poomba asked:


I have a limit to how much insurance I have per year and my chiropractor seems to charge considerably more if the insurance company is paying then to me directly. Is this legal?

8 Responses to “Is a chiropractor allowed to charge more to an insurance company than they do to a client directly?”

1. Dan B on April 22nd, 2009 10:37 am

   Generally, yes. It is legal.

   All doctors are allowed to charge a set fee to the insurance company for the service provided. But it is dependent upon the type of coverage you have and the agreement between the doctor and insurance company. If the insurance company and the doctor agree that a certain procedure can be billed for $250, then it’s legal. Now some agreements prohibit the doctor from charging you the difference if the agreed price is less that what the doctor normally charges uninsured patients.

   And some doctors, knowing that the patient has no insurance, can cut the patient a break on the costs. Dentist did that with my daughter’s braces (10% discount).

2. eskimooinc.com on April 24th, 2009 5:41 am

   The whole medical billing industry in this country is a total rip off, riddled with inconsistencies and dodgy practises. It used to be that medical practitioners were (rightly) viewed as upstanding pillars of the community….now because of the billing and misbilling rip-offs they are, frankly, little better than snake oil salesman.

   So to answer your question, no it is not unusual, and I don’t believe it is actually illegal. Quite incredible that we put up with this - more shame to the politicians of the greatest democracy, greatest economy in the world for allowing this to continue!

3. Kay on April 25th, 2009 10:46 am

   In my experience, doctors and hospitals charge a lot more to insurance company than to the patient who pays directly out of his/her pocket. It’s the same with auto insurance on damage claims. It’s legal. This is the main reason our healthcare costs and other insurance costs continue to rise.

   But it’s not legal if a doctor charged you an amount and received the payment from you, and at the same time sent a billing to your insurance company at higher amount trying to obtain the money from your ins. co.

4. dezbah1911 on April 28th, 2009 4:06 am

   No, it isn’t legal, but you may want to check your state laws first. It’s also a possibility that your chiropractor was giving discounted rates to you when you paid for services on your own (some do that - mine does). When the insurance company is billed, he may be charging full price. Hope that helps!

5. mbrcatz on May 1st, 2009 10:10 am

   Yes. They’re allowed to charge as much as they want, in the USA. There is no price fixing.

6. Lori S on May 3rd, 2009 7:52 pm

   Doctors can charge whatever they like to whomever they like. What they are reimbursed however is based on the negotiated rate they have with the insurance company and if they are a preferred provider or out of network. If they are preferred, they have a set amount already agreed to that they will accept.

   If you are paying them cash, they can charge less-partly because there is no hassle in billing or waiting for the payment.

7. Ceasars Mom on May 4th, 2009 1:36 am

   What a physican charges is completely different than the “allowed amount”, this is the amount that the physician is actually contracted to be paid by the carrier.

   for example: if a physician charges $125 for a service, the insurance only allows for payment of up to $100. The physician, as a contracted provider would have to “write off” $25

   Your policy maximum would have to be defined by your insurance company as either the “Physician Charges” or the “Allowed amount”

   Contact your carrier to clarify.

8. skeptical thinker on May 7th, 2009 12:23 pm

   Depending on the specific situation, its probably not illegal. It depends on what the chiropractor does with all of his other patients. I do think that it is probably a little unethical, but I wouldn’t worry about it too much. I’ve noticed that especially among chiropractors, this is very common, and some have even gotten into serious legal trouble over this. Chiropractors are often in desperate need of patients, so they’d gladly reduce your costs as much as possible and take whatever the insurance will give them. But this isn’t the purpose of the law. The law says that in isolated cases, its fine. The purpose should not be designed as a way to get and keep patients by offering “free treatment” while only billing their insurance. If it happens once in a while, fine. But if its the standard policy, not fine.

   It is illegal to routinely excuse patients from insurance copays and deductibles. It is legal to waive a fee for people with a genuine financial hardship, but it is not legal to provide completely free care or discounts to all patients or to collect only from those who have insurance. Studies have shown that if patients are required to pay for even a small portion of their care, they will be better consumers and select items or services because they are medically needed rather than because they are free. Routine waivers thus raise overall health costs. They are considered fraudulent because averaging them with the doctor’s full fees would make the “usual” fees lower than the amounts actually billed for.