Should you enroll with payers?

How this calculates

Enrolling does two things at once. It brings visits you would not otherwise have seen, and it converts some visits you already had into lower-paying ones. The calculator nets those against each other and subtracts the cost of billing.

The switching rate is the variable that decides it

Most practices model the new patients and forget the existing ones. A cash patient who carries insurance has been paying your full fee because you were out of network. The moment you are in network, that same visit pays your contracted rate instead. No new patient arrived. The revenue just fell. If your switching rate is high and your capacity is nearly full, enrolling can reduce collections while increasing your workload — and that is not an edge case.

What the calculator does not model

• Who does the billing. The billing-cost slider is a blended placeholder. Hiring a biller versus using a service is a separate decision with its own calculator.
• Credentialing time. Commercial payer enrollment commonly runs 90 to 180 days from a clean application. Nothing in this model happens until that finishes.
• The learning curve. A practice new to insurance has no denial history and no payer-specific rules knowledge. Real first-year leak is usually worse than the figure you set.
• Visit caps and authorization. Commercial plans commonly limit chiropractic to roughly 20 to 26 visits a year and require authorization beyond the first several. A care plan longer than the cap does not become uncollectible, but it does become a conversation.
• Patient mix effects. Insurance patients and cash patients do not always behave the same on retention, plan completion, or no-shows.

If you enroll, the next question is who bills

Hiring a biller or using a full billing service is a separate decision with different arithmetic, and the answer is not the one most owners assume. It is not a salary against a percentage. Both cost you the same two things — what you fail to collect, and what you pay to collect it — and a billing operation that collects seven points worse than another costs you far more than the fee difference between them.

Open the RCM billing calculator →  It returns the collection rate an in-house biller has to reach before she beats a success fee at your revenue.

Read the long version

Should your cash practice start billing insurance? — for chiropractic practices
Should your private-pay practice take insurance? — for mental health practices
In-house or outsourced billing: the number that actually decides it

Where the defaults come from

• Chiropractic. The Chiropractic Economics annual Fees and Reimbursements Survey has tracked fees against reimbursement for nearly three decades; its 2024 edition found practitioners collecting roughly 56 to 57 percent of billed fees. Cash-only practices have run between about 10 and 20 percent of survey respondents over the past decade.
• Mental health. Heard’s Financial State of Private Practice Report put the average private-pay rate for individual therapy at $159 against an average insurance reimbursement of $111 — about 30 percent less. Its following edition found the gap holding at 25 to 35 percent.
• Leak. A Premier survey of providers found nearly 15 percent of private-payer claims denied on first submission, with about 54 percent eventually overturned after appeal — meaning close to half of denied dollars are never recovered without a working appeals process.
• In-house billing cost. BLS reports a median annual wage of $51,140 for medical records specialists as of May 2025, with the tenth percentile below $37,000 and the ninetieth above $81,150.

This is a planning model, not advice. It uses your numbers and published benchmarks to show the shape of the trade. Contracted rates vary enormously by payer, state, and specialty, and your own rates are the only ones that matter to your answer.