The Insurance vs. Self-Pay Appointments chart displays the number of visits associated with insurance claims versus self-pay (out-of-pocket) appointments, grouped by appointment type.
Each bar represents how many appointments were billed under insurance and how many were paid directly by patients within the selected date range.
This KPI helps you understand your payer mix — the distribution of visits and revenue sources across your patient base.
Your payer mix has a direct impact on your practice’s financial health, operational workflow, and patient accessibility.
Insurance-based appointments provide a steady stream of reimbursements but often involve longer billing cycles and higher administrative effort.
Self-pay appointments, on the other hand, provide immediate cash flow and less complexity but may depend more on patient affordability and perceived value.
Monitoring this balance allows you to:
Evaluate financial stability and billing efficiency.
Anticipate cash flow needs based on reimbursement timelines.
Align marketing and care strategies with your preferred payer distribution.
An unbalanced mix — such as being overly reliant on insurance — can expose your practice to delayed payments and payer policy changes.
Review the ratio of insurance to self-pay appointments monthly or quarterly. A heavy tilt toward insurance may indicate dependency risks, while too high a self-pay share may signal patient affordability challenges.
Use this chart to project short-term and long-term revenue flow. Self-pay income provides immediate liquidity, while insurance claims require processing time.
If your self-pay percentage is growing, ensure your cash pricing and care plan packages remain competitive and clearly communicated to patients.
Promote services or plans that attract your ideal payer mix. For example, wellness memberships or bundled care plans can increase recurring self-pay visits.
Use historical trends to compare current performance against previous quarters to determine whether your payer balance is improving or drifting.
For most chiropractic practices, an ideal payer mix ranges between 60–75% insurance-based visits and 25–40% self-pay visits.
Maintaining this balance helps ensure reliable reimbursement without excessive administrative burden, while also allowing flexibility to grow cash-based wellness care.
Practices that diversify their payment models — offering care plans, wellness memberships, or family packages — often achieve higher self-pay ratios and more predictable cash flow.
Improves understanding of revenue source stability
Helps balance cash flow vs. claims processing
Informs marketing, pricing, and care plan decisions
Reduces risk exposure to payer policy changes
Supports sustainable growth and financial independence