March 2006

see also: WCA supports DCs' right to offer pre‑paid services

World Chiropractic Alliance Policy
on Pre‑Payment of Chiropractic Services

The World Chiropractic Alliance recognizes that doctors of chiropractic may elect to charge a case fee for professional services, may permit patients to pay for professional services in advance and/or care may be offered and paid over fixed time periods, for example on a yearly basis. Fee structures and agreements are routinely negotiated on such bases between the chiropractor and the patient.

These may include family case fees where there are two or more members of a family under care. In such situations it is not uncommon for discounts to be provided for fees paid in advance and/or discounts for each additional family member under care.

Such arrangements are common in other clinical specialties and professions, for example: orthodontics, obstetrics, and law.

It is the position of the WCA that such practices are usual, customary, and ethical provided that the financial agreements are explicitly revealed in a document signed by the patient and the doctor and provided that the fees are reasonable considering the care being provided.

It is further the position of the WCA that regulatory bodies should consider such practices to be in compliance with the laws, rules, and regulations of the jurisdiction where the chiropractor practices.

It is not uncommon for provisions to be made ensuring that funds are not expended until services are provided and that patients may receive a prompt refund of unused fees upon request.

One method that chiropractors may use who charge case fees and/or accept prepayments is to employ a trust account, separate from the doctor's personal or business account, to hold unearned fees until professional services are actually provided.

"Trust funds" are defined as unearned fees in the form of cash, or property other than cash, which are received by a chiropractor prior to the chiropractor rendering professional services for which such fees are received.

If a trust fund is used, the following trust accounting procedures are recommended:

(a) A separate bank account other than the chiropractor's regular business or personal account designated for the deposit of such funds.

(b) A journal, file of receipts, file of deposit slips, or checkbook stubs listing the source and date of all receipts of trust funds.

(c) A journal which may consist of canceled checks, showing the date and recipient of all trust funds disbursements.

(d) A file or ledger containing an accounting for each person from whom trust money has been received.

(e) Retain all canceled checks drawn on the trust account.

Trust account records should be retained for a period of at least six (6) years.

Case fees, paying for professional services in advance, paying for care over fixed time periods, family case fees and discounts for fees paid in advance are mechanisms that doctors of chiropractic utilize in order to assist patients in managing their health care finances. Such efforts are an inherent part of the ethical responsibility of health care providers to lessen the financial barriers to needed care.