The Quiet Exit: Why Chiropractors Leaving Insurance Networks Is Becoming a Compliance Headache

Let’s talk network adequacy, a cornerstone of insurance compliance that's becoming harder to maintain as the chiropractic industry shifts beneath our feet.

Health plans are under constant pressure to meet state and federal adequacy requirements, ensuring a sufficient number of providers including PCPs, pediatricians, specialists, and yes, chiropractors are available within specific geographic regions. But what happens when an entire subset of providers starts opting out of the system?

Based on both direct contracting experience and industry-wide research, a trend is clear: chiropractors are increasingly abandoning insurance networks in favor of cash-based models. With average out-of-pocket visits priced around $75, patients often find these fees manageable and chiropractors, in turn, benefit from immediate payment and cleaner operations. Many now offer monthly membership-style services with flexible terms and no cancellation fees to encourage return visits.

Here’s the problem:

When most local chiropractors won’t contract with health plans, especially in rural areas, insurers are left with two unappealing options:

1. Contract at significantly inflated rates with large national chiropractic groups to technically meet adequacy standards, or

2. Fail to meet adequacy for the specialty despite exhaustive outreach and prepare to justify it to regulators.

This raises urgent questions for the industry:

• Do adequacy standards for chiropractors need reform as care models evolve?

  
  

• How should payers respond when provider preferences clash with compliance

  obligations?

  
  

• How do insurance providers build adequate and compliant networks?

At TotalMedNetworks, we work closely with payers to navigate these new provider behaviors, helping craft compliance strategies that are both realistic and regulator-ready.

Let’s open this conversation:

Have you seen this shift in your networks? Are your adequacy reports starting to reflect the chiropractic gap?

Learn more at: www.totalmednetworks.com

 Legal Note:

This post is for informational purposes only and does not constitute legal or financial advice.

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