I want to be straight with you, because you deserve that more than a polished line on a webpage.
For a long time, we were in-network with Highmark. Things changed — and we’re genuinely sad about it, because it means some of you have to jump through an extra hoop to see us. Here’s exactly what happened, in plain terms:
For years we billed Highmark the same way, and every time they audited us, we came through clean. Then their rules changed. They decided that certain services done on the same visit “overlapped” in time and therefore couldn’t both have happened — something they had never once flagged, never once asked us to document differently. And what they grilled us on isn’t even part of standard Medicare note-taking, which is the bar everyone else in this field uses. From an audit of fifty visits alone, they claimed everything in certain categories had to be paid back — almost half a million dollars.
After a year working alongside our attorney — who does post-payment audit defense for chiropractors, and was recommended to us by our malpractice insurance — we got a real number: roughly $15,000, plus a corrected plan.
But by then the harder thing had already happened. For the whole of 2024, Highmark simply stopped paying us for the Highmark patients we were treating — over $300,000 of care we had already given. We sent in hundreds of records to get paid, and they denied every single one — this time because we hadn’t written down the exact minute we walked into the room and the exact minute we walked out. That was never a requirement before — not even during the discussions of the initial audit that led to them trying to recoup funds they claimed they’d paid us in bad faith. They had never asked for it, and it isn’t how these notes are standardly kept. We even had an independent chiropractor, working with an attorney, audit every single one of our notes — and every single one cleared. That unpaid year is what forced us to sell two of our offices to keep the rest of the practice alive.
We’re not saying this to be dramatic — we’re saying it because, to us, this story reeks of greed on Highmark’s end. Here’s a fact worth knowing: auditors justify their own positions by how much they recoup. They’re financially rewarded for how much they’re able to collect back. Dangle that kind of carrot in front of anyone and it’ll shift the ethics of some of them — and others just don’t care. They might even dislike chiropractors. Who knows.
I’ve since reported Highmark to the Pennsylvania Insurance Department. Their demand has climbed from around $430,000 to more than $2 million, and we are still standing in that fight today.
They have little ground to stand on. Their claim is incredibly weak, and it has only ever been fought internally — within Highmark’s own board and legal system. It has never reached a real court outside of that, nor will it, because out there the real-world rules apply. Right now they can bulldog and change things only because they make the rules — and ironically, one of those rules is that they can break their own rules without consequence. This entire thing should never have happened. We were simply targeted because we grew fast, and we saw a lot of Highmark patients.
Not being in-network with Highmark stung, and almost bankrupt us. But it forced me to look at something I wasn’t focusing on completely yet: I’d built this whole practice on ground I didn’t control. I’d been building my house on sand — and one decision by one insurer could wash a piece of it away.
So I started building on rock instead. That single moment is the reason for almost everything that’s come since:
It sent me into the research — which became Edge Cracking, the book. The research led to the inventions (EdgeX). And all of it pointed back at the same thing: care that doesn’t depend on an insurance company’s permission to be good. Your spine, your health, your understanding — that’s the ground we build on now.
So while I’m sorry Highmark and we don’t line up anymore, I won’t pretend it didn’t change everything for the better. It did.
If Highmark is your plan, we don’t want that to be the reason you stay in pain. So your first visit is $25 off — come see what care looks like when it’s built on rock.
And remember: even out-of-network, you can submit your own bill to your carrier for reimbursement. We can’t promise anything, and we won’t call your insurer or file the claim for you — but plenty of patients have gotten money back, and we’ll hand you the itemized paperwork you need to try.