Chiropractors in Washington

What Washington changes about chiropractic care

The Washington Chiropractic Quality Assurance Commission wrote two rules that a patient can actually use. WAC 246-808-550 states that it is unprofessional conduct for any chiropractor to enter into a contract which would obligate a patient to pay for care to be rendered in the future, unless the contract provides that the patient is entitled to a complete refund for any care not received. The prepaid multi-visit plan is not banned in Washington. Signing one without that refund term is what the rule reaches.

WAC 246-808-585 handles the other common front door: all offers of free X-rays must be accompanied by a disclosure statement that X-rays shall only be taken if clinically necessary, in order to avoid unnecessary radiation exposure. An advertisement in Washington offering free imaging with no such statement is not following the rule.

WAC 246-808-630 covers the money around free and reduced-cost offers. Free or reduced services must be available equally to all interested parties, no charge may be made to any individual or third-party payor for services provided free, and billings must accurately reflect the actual charge including any discounts, reduced fees or waiver of copayment. Advertising forgiveness of coinsurance is prohibited unless the insurer gets complete information about the actual charge.

How to choose a chiropractor in Washington

Most of what goes wrong is financial rather than clinical, and it happens at the first or second visit when a treatment plan and a payment plan are presented together. Separating those two conversations is the single most useful thing a patient can do.

• If you are offered a package of future visits, read the refund clause. In Washington that clause is what makes the contract permissible at all.
• Ask what happens if you move, change insurers, or simply decide to stop. The answer should match what the contract says, in writing.
• Treat a free X-ray offer as a prompt to ask whether imaging is clinically necessary for your presentation. The disclosure rule exists because the answer is often no.
• Ask for a written treatment plan with a review point — a number of visits after which progress gets reassessed rather than assumed.
• Verify the license on the Washington Department of Health provider credential search before the first appointment.
• Ask whether the clinic bills your insurer directly and what your share is per visit, not per package.
• If you have a specific diagnosis or recent injury, ask what would make the chiropractor refer you out rather than treat.

Questions to ask at the first visit

• If I prepay for a course of care, what is your written refund policy for visits I do not use?
• Are the X-rays clinically necessary for my case, and what would change if we skipped them?
• How many visits before we reassess whether this is working?
• What is my cost per visit, and what does my insurer actually cover?
• What would make you refer me to another kind of clinician?
• Can I have the treatment plan and the payment agreement as two separate documents?

This is general information, not medical or legal advice. Washington administrative rules are amended periodically, so confirm the current text of chapter 246-808 WAC and a practitioner’s license status with the Washington State Department of Health.