The Insurance Objection Playbook

The insurance objection is when a caller asks “Do you take my insurance?” and pulls back when the answer is no. In a cash or out-of-network practice, it's usually a cost question in disguise. Answer it honestly, with real options like superbills, HSA and FSA cards and financing, and the call keeps going.

Here's the kind of email that started this guide. A cash-practice client told us many of their Google callers only want to use insurance. When the front desk mentions the New Patient Special, callers say some version of “Thank you, but I'd rather go some place I can use my insurance.” Then they hang up.

When we dug into the account, we saw two other things: a seasonal dip, and leads that weren't getting a second call. The insurance objection was real, but it wasn't the whole story. That's worth knowing before you blame the insurance question for a slow month. The objection gets the blame because it's the thing people say out loud.

Every one of those calls is a lead you already paid for, with ad spend, SEO work or years of reputation. When the front desk hears “insurance” and answers “No, but we have a New Patient Special,” it has answered a question the caller didn't ask. The caller wanted to know what this will cost, whether it's worth it, and whether the money they spend on insurance can help. A flat no answers none of that.

What you'll walk away with

• Word-for-word phone, text, email and in-office scripts that answer the insurance question honestly and keep the conversation going.
• A chiropractic superbill template and field checklist built from what Cigna, UnitedHealthcare and Aetna ask for.
• A print-ready patient handout and step-by-step SOP for submitting a superbill, plus the questions to ask the insurer.
• The Medicare, Medicaid, auto and work-injury exceptions, in plain language. This is where cash practices get in trouble.
• A payment options menu: Cherry financing, HSA and FSA, short payment plans and packages, with the cautions that come with each.
• A follow-up system, a slow-season playbook, a weekly tracking sheet and a 7-day action plan.

Most of the time the caller is really asking: What will this cost me, and is it worth it? Sometimes it's something else: habit, trust, a spouse who handles the money, or a bad experience with a surprise bill. Either way, your team answers the insurance question first, with the fix in the same breath, then sorts the caller before quoting a price or offering times. If the caller still hesitates, that's when they find out which one it is.

One more thing that trips up practices and patients: out-of-network reimbursement is figured from the plan's allowed amount, not from your fee. HealthCare.gov defines the allowed amount as “the maximum amount a plan will pay for a covered health care service.” That's exactly why nobody on your team should ever promise a patient what they'll get back.

Sort every caller before you quote a price or offer times

1. PPO or POS plan through work or on their own, or not sure of the plan type: the superbill answer, then two times (Parts 5 and 6).
2. HMO or EPO: skip the superbill. These plans usually don't cover out-of-network care, so the caller pays you directly by card, HSA or FSA card, or a Cherry payment plan if they qualify. Then two times.
3. Medicare, including Medicare Advantage: hand off to a trained person. No cash price, no ballpark, no superbill (Part 7).
4. Medicaid: ask them to call their plan first, and offer to hold a time while they check. Coverage depends on the state and the plan.
5. Car accident or work injury: a separate intake process. Those claims follow their own rules.
6. No insurance, or insured but not using it: your cash price plus a written Good Faith Estimate.

Then teach your team one simple framework for any objection. It's adapted from Carew's LAER model (Listen, Acknowledge, Explore, Respond).

The 4 A's

• Acknowledge. Three words or fewer, like “Got it” or “Sure,” or skip it and go straight to the answer. Don't say their concern back to them or give a sympathy speech.
• Answer. Give the fix in the same breath so “we're out of network” never hangs: “We're out of network, so what we do is give you a superbill.” Make it sound routine (“We do this all the time”), tie any payback to “depending on your plan” and save the details for the visit.
• Ask. Find out what's going on and sort the caller: plan type, Medicare or Medicaid, an injury. If they hesitate, find the one thing holding them back (cost, schedule or the insurance part) and answer it in a line.
• Advance. Offer two specific times, then stop talking. Still unsure? Offer to hold a time that's easy to move. Once.

Never say this

• “No, we don't take insurance.” (then silence)
• “It depends on your insurance,” as your whole answer. It sounds evasive. Say what it depends on and when they'll get the details: “Depends on your plan, and we'll break it all down for you when you come in.” Then offer two times.
• “Your insurance will pay you back” or “It should cover most of it.” That's a reimbursement promise. Tie any payback to “depending on your plan” and keep it to “part of it,” the way the scripts do.
• “We'll waive your copay or deductible” or “We'll code it so insurance pays.” The OIG and Florida law treat these as fraud risks.
• “Insurance companies are a scam.” It insults the caller's choice.
• “You'll only need X visits” or “You'll get better faster here.” Those are outcome claims.
• “Everyone gets approved” or “It's 0% interest.” Cherry says eligibility isn't guaranteed, and 0% APR depends on approval and on-time payments.
• To a Medicare caller: “Medicare doesn't cover us, so just pay cash.”
• Any symptoms or diagnosis in a voicemail or text.
• “The special is only good today.” Fake urgency.

An article published on the California Chiropractic Association's website in May 2026, written by Dr. Ray Foxworth of ChiroHealthUSA (a discount medical plan company), argues that doctors should lead the clinical conversation and stay out of fee negotiation, with staff working from a written financial policy and a menu of pre-approved options. We agree with the principle: every patient hears the same terms, and the doctor's time goes to findings and recommendations, not haggling.

A superbill is a detailed statement you give the patient instead of filing a claim with their insurance. It carries CPT and diagnosis codes, your NPI and tax ID, what was charged, what the patient paid, and a zero balance. The patient sends it to their insurer to ask for reimbursement or credit toward their deductible. KMC University puts it plainly: superbills are “not a workaround for payer contracts or Medicare rules.”

Think of it as the patient's version of a CMS-1500. The CMS-1500 is the standard paper claim form for professional providers, and the provider or its biller submits it. A superbill carries the same data, but the patient submits it, usually along with the insurer's own member claim form.

Why these fields? Cigna's member claim form asks for the professional's name and credentials, address, tax ID, a procedure code, the charge and an ICD-format diagnosis, and says it “can't accept receipts, balance due statements and cancelled checks” in place of an itemized bill. UnitedHealthcare's member page asks for the tax ID, diagnosis codes, procedure codes with modifiers, units, the billed amount per code and the place of service code. Aetna's form asks for days or units, amount paid, a physician signature and the NPI. Cover all three and you've covered what these three major carriers ask for.

How should the fee appear? Experts differ. KMC University suggests listing your office fee, then the discount as its own line, then the amount paid. A Florida health law firm suggests billing everyone the same fee and accepting less as payment. Dynamic Chiropractic warns never to let any patient billing reflect “an amount higher than what they paid.” All three agree on the part that matters: the superbill shows what the patient actually paid. Pick one format with a healthcare attorney or a chiropractic billing specialist and use it for every patient. KMC's rule of thumb is a good one: “your fee is your fee is your fee.”

Coding rules that keep superbills clean

• The doctor chooses codes, not the front desk, and every code must be supported by the notes. Insurers can ask for records, and Cigna's form says so.
• Spinal manipulation codes: 98940 (1 to 2 regions), 98941 (3 to 4 regions), 98942 (5 regions). 98943 is extraspinal.
• Timed codes like 97110 and 97112 are billed in 15-minute units, and services under 8 minutes aren't reported (American Chiropractic Association). Supervised modalities like 97012 and 97014 aren't timed.
• An E/M visit on the same day as manipulation must be separate and distinct, with modifier 25. The American Chiropractic Association notes some payers deny almost all established-patient E/M codes billed with manipulation, even when modifier 25 is used correctly, a position the association calls extreme.
• New patient office E/M codes are 99202 to 99205. Code 99201 was deleted in 2021 (American Medical Association).
• ICD-10-CM codes update every October 1, with occasional April 1 updates (CMS), and most CPT code changes take effect every January 1 (American Medical Association). Review your template's code list at least once a year.

What about apps that file claims for patients? They exist, but we aren't recommending one yet. Reimbursify lists specialties like mental health and physical therapy but did not list chiropractic when we checked. Thrizer is built for therapists. If a vendor confirms in writing that it supports chiropractic claims, it may be worth a look.

Here's the honest pitch: you can't promise a patient anything about reimbursement, but you can make the process easy. That alone sets you apart from the office that says “no” and moves on. Everything below also appears in the print-ready patient handout at the end of this guide.

For the patient: check benefits before the first visit

1. Look up “Chiropractic care” in your Summary of Benefits and Coverage. Every plan's SBC must list it as either covered or not covered. The SBC also shows the plan's general out-of-network deductible and cost sharing, though it may not show a chiropractic-specific amount.
2. Try your insurer's online cost estimator. Under federal price transparency rules, it may show an out-of-network allowed amount for covered services. Search a code like 98941.
3. Call the member services number on the back of your card and ask the questions below.
4. Write down the rep's name, the date and the call reference number.

How the patient submits a superbill

1. Log in to your insurer's member portal and find “Submit a claim,” or download the member medical claim form.
2. Fill in the member section. Leave the “pay the provider” or assignment of benefits section blank, because you already paid.
3. Attach the superbill and proof of payment. Keep copies of everything.
4. Upload it, or mail it to the claims address on your ID card.
5. Submit monthly, or as soon as you can. Filing deadlines vary by plan.
6. Watch for your Explanation of Benefits (EOB). If the claim is denied, call the insurer, ask why, and ask about the appeal process.

Front-desk SOP

• Run, or coach the patient through, the benefits call before visit 1.
• Hand over or email the superbill at checkout, or send a monthly roll-up.
• Give every new cash patient the one-page handout. A QR code on a front-desk sign works too.
• Log each superbill in your CRM with the date sent.
• At 30 days, check in: “Did you hear back from your insurance? Anything we can help with?”
• If an insurer asks for records, route it to the doctor.
• If a patient signed the assignment box by mistake and the insurer pays you, flag it to the office manager right away so the patient is refunded promptly. Florida example: practitioners who file claims must refund patient overpayments within 30 days of determining one (Fla. Stat. 456.0625). Ask your attorney how that applies to you.

What Medicare covers from a chiropractor

• Only manual manipulation of the spine to correct a subluxation (98940 to 98942, with the AT modifier for active or corrective care).
• The patient pays 20% of the Medicare-approved amount after the Part B deductible (Medicare.gov).
• Everything else a chiropractor furnishes or orders is not covered, including exams, X-rays and therapies.
• Maintenance care, once further clinical improvement can't reasonably be expected, is not considered medically necessary. To bill the patient for maintenance manipulation, give a valid Advance Beneficiary Notice (ABN) before the service and add the GA modifier to the claim. One ABN can cover a repeated service for up to a year if it names the service and frequency.
• Exceptions to filing are narrow. The two a chiropractor sees most: the patient freely refuses to authorize a Medicare claim for covered care (Medicare's charge limits still apply), or, for care Medicare won't cover such as maintenance, the patient picks Option 2 on a valid ABN signed before the service. Have a Medicare billing specialist set your policy.
• Non-participating providers who don't accept assignment can't collect more than the limiting charge, which is 115% of the non-participating payment amount (42 U.S.C. 1395w-4(g)(2)(C)).

Violating mandatory claim submission can bring civil money penalties and exclusion from Medicare. Health-law commentary also holds that there's no “cash practice exception” for covered active care if you aren't enrolled. That last point is legal interpretation, not a single CMS sentence, so talk to a healthcare attorney before you see Medicare patients for cash.

Medicare Advantage plans have their own rules. KMC University warns that a non-network chiropractor should charge a Medicare Advantage patient directly only after confirming the patient isn't in a Private Fee-for-Service plan and isn't a Qualified Medicare Beneficiary (QMB). Bring in a Medicare billing specialist before you set a policy.

Medicaid: chiropractic is an optional benefit, so each state decides whether and how much to cover. Providers who take part in Medicaid must accept Medicaid's payment, plus any required cost sharing, as payment in full. Patients can't always submit their own claims either; that depends on the state plan. Florida example: a Medicaid provider must tell a recipient before each service that they're responsible for services Medicaid doesn't cover, and may bill the recipient only in listed situations. The simple front-desk move: ask the patient to call their plan first.

Auto accidents and work injuries (Florida examples): PIP pays medical benefits only if initial care is received within 14 days of the accident (Fla. Stat. 627.736), and it has its own limits and rules. Florida workers' compensation law says a provider “may not collect or receive a fee from an injured employee” except as that chapter allows. A superbill is the wrong tool for either one. Give them their own intake path.

If the front desk only says “No, we're cash, but we have a New Patient Special,” the call ends. A practice that can answer with a clear price, a way to use HSA money, a superbill and a payment plan gives the caller a reason to stay on the phone. On the phone, lead with the fix that fits the caller's plan, like the superbill for a PPO, and keep the rest of this menu ready if cost comes up. Financing and packages are options the patient can choose, never the default.

Under the No Surprises Act, you owe a written Good Faith Estimate to uninsured and self-pay patients, and “self-pay” includes insured people who aren't asking you to bill their plan. Many cash practices assume it only covers the uninsured. It doesn't. Post a notice that GFEs are available on your website, in the office and wherever scheduling happens, and say it out loud when cost comes up. One GFE can cover a care plan of up to 12 months (45 CFR 149.610), and a patient can dispute a bill that runs $400 or more over it (45 CFR 149.620). Medicare and Medicaid patients are generally excluded. For services Medicare doesn't cover, such as a chiropractor's exam, giving a GFE anyway is the safer habit. Treat it as a trust signal: a written number answers the money question directly.

HSA and FSA: what the owner needs to know

• The basis: IRS Publication 502 says “You can include in medical expenses fees you pay to a chiropractor for medical care.”
• HSA money covers expenses only to the extent they aren't paid by insurance (IRS Publication 969). A patient who pays with an HSA and later gets reimbursed by their insurer should talk to their account administrator or tax advisor. Your team should not give tax advice.
• FSA card charges that aren't automatically verified stay pending until the patient sends proof, like a receipt showing the service, date and amount (IRS Notice 2006-69). Itemized receipts every visit help.
• FSA and HRA cards work only at merchants with health care merchant category codes. Ask your card processor to confirm your practice is coded 8041 (Chiropractors).
• FSA plans count an expense when the care is provided, not when it's paid (proposed Treas. Reg. 1.125-6), so an FSA card charge for a prepaid package may be denied or need to be paid back. For FSA patients, charge per visit or allocate the package to each visit. For HSAs and the tax deduction, IRS Publication 502 says payments for care to be provided substantially beyond the end of the year generally can't be counted. Ask patients to check with their plan administrator before using an HSA or FSA for a package.
• FSA money generally must be used within the plan year, with a grace period or carryover only if the employer offers one.
• Never market a membership as HSA-eligible. The new HSA rule for direct primary care (from the 2025 One Big Beautiful Bill Act, explained in IRS Notice 2026-5) covers only family, internal, geriatric and pediatric medicine physicians, nurse practitioners, clinical nurse specialists and physician assistants. Chiropractors aren't included.

Option 5: Cherry. Cherry is a patient financing platform that lists chiropractic among its supported specialties. Full disclosure: CHIROBASIX is building a partnership with Cherry, so weigh our take with that in mind. Here's what Cherry says about itself on withcherry.com as of September 2026. These are the company's own statements and can change, so re-check them before you rely on them.

What Cherry says

• It is “a financial technology provider and platform, not a bank or a lender.” Cherry says its loans are made by Lead Bank, Member FDIC, and that some plans are retail installment contracts extended by the practice itself.
• Checking eligibility uses a soft credit check that doesn't affect the patient's credit score. Cherry also reports plan status to Equifax, TransUnion and Experian, so missed payments can show up on a credit report.
• Plans run 0% to 35.99% APR, over 1 to 60 months, for $35 to $65,000. 0% and other promotional rates depend on eligibility, and eligibility isn't guaranteed. A 0% APR rate holds only while payments are on time: Cherry says that if an account becomes delinquent, interest may apply going forward.
• Approved patients are offered an interest-free pay-in-four option, and Cherry's homepage says it charges no deferred interest. Its disclosures also describe a Waived Interest Promotion that some practices opt into: interest builds and is credited back only if the full balance is paid by the promotion end date, with every payment made within 15 days.
• A down payment is due at checkout, there's no fee for paying early, and a late fee may apply if a payment isn't received within 15 days.
• For the practice: free signup, a merchant fee deducted before payout that varies by plan type and volume, payment in 2 to 3 business days, and Cherry services repayment.

CareCredit is a credit card issued by Synchrony Bank. Its promotional financing is deferred interest: interest builds from the purchase date and is added if any promo balance remains at the end. Prequalifying is a soft check, but moving on to apply triggers a hard credit inquiry. Its chiropractic page says packages and treatment plans must be completed within 90 days of the first transaction, though select providers can offer other time periods.

People search this question directly. SEMrush estimated (US, September 2026) about 2,400 monthly searches for “do chiropractors take insurance” and about 260 for “how much is a chiropractor without insurance.” If your website doesn't answer it, the caller brings the question to your front desk instead.

Google Business Profile

• Leave the “Accepted health insurance” field empty. Never list networks you aren't in.
• In your description, add a line like “Out-of-network practice. Superbills provided. HSA and FSA accepted.” Leave prices out: Google says descriptions can't focus on promotions or prices, can't include links, and can't go over 750 characters.
• Put your New Patient Special in Posts, with any required disclosures.
• Don't count on Q&A. Google discontinued the Business Profile Q&A API on November 3, 2025, saying it was updating how Q&A works. Put the answer on your website.

Google Ads

• Add phrase-match negative keywords like “accepts insurance,” “takes insurance,” “in network,” “covered by,” medicaid and medicare. Don't add “insurance” on its own, or you'll block searches like “chiropractor without insurance.”
• Review the search terms report every month.
• If your account is eligible for Google lead form assets (Google's lead form policy excludes healthcare-related ads, so many chiropractic accounts are not), add a qualifying question such as “How do you plan to pay?” with choices like Self-pay or HSA/FSA, Want to use out-of-network benefits, or Only in-network insurance. Otherwise, put the same payment-preference question on your landing-page form.
• Ask about payment preference only. Never ask about coverage details or health conditions.

Meta (Facebook and Instagram)

• Don't ask for insurance information on Instant Forms. Meta doesn't allow insurance or health questions without its prior permission.
• Put “Out-of-network. Superbills provided.” in the ad copy or on the form's intro screen.
• Test the Higher intent form type, which adds a review step before someone submits.

On landing pages, state your payment model above the fold, right next to the offer. A caller who already knows you're out-of-network before they dial won't be surprised when your front desk says it.

Remember the practice from Part 1? The bigger fix wasn't the script. It was the season and the follow-up. Great scripts can't fix a lead nobody calls back.

The slow-season playbook

• Check the season first. Pull 24 months of new patients by month before you blame the calendar. Seasonal patterns, like snowbird months in warm-weather markets, are plausible, but your own data decides.
• Reactivate. Run a campaign to patients last seen 6 to 24 months ago. Send reactivation texts only to patients who gave written consent to texts. Use email for everyone else.
• Referrals. Run a referral campaign, but have counsel review any reward first. Florida example: the Patient Brokering Act applies to all payers, not just Medicare.
• Teach. In slow months, run workshops, events, educational videos and emails.
• Q4: the FSA reminder. FSA money generally must be used within the plan year, so a “check your FSA balance” message fits. Plan years and grace periods vary, so don't assume December 31.
• New plan year: deductible education. Deductibles reset each plan year, and plan years don't always start in January. Explain it; don't overstate it.

Start with a 30-day baseline before you change your offer, your ads or your price. Then change one thing at a time, so you know what actually moved the number.