Chiropractic Answering Service: What It Must Never Say

The pages that sell chiropractic answering services all promise the same thing: no more missed new patients. That part is easy. The part nobody writes about is the caller who says her foot has gone numb, or asks whether Medicare will pay, or wants to know if it is safe to wait until Monday - and gets an answer from someone who is not a chiropractor. This guide is built around those calls. We make an AI receptionist, so we have a stake in the outcome; the rules and clinical sources below are linked so you can read them without us.

The short answer

A chiropractic answering service answers your line when your front desk cannot, books and moves appointments, takes messages and answers factual questions. It should do nothing clinical: no opinion on what a symptom is, no advice on what to do about it, no reassurance that it can wait. For most calls that boundary never comes up. For the few where it does, the service needs a written list from you of what counts as an emergency, what must reach you before a routine visit is booked, and what it may say about insurance and price.

A general medical practice has the same problem on a larger scale; our medical answering service guide covers that. Chiropractic has its own shape - a very small team, a large self-pay share, and a set of musculoskeletal symptoms where the dangerous version and the routine version sound alike on the phone.

Why the phone goes unanswered

Because there is usually nobody free to answer it. In the National Board of Chiropractic Examiners' 2025 Practice Analysis, a survey of 3,876 chiropractors, 49% worked in a single-doctor office, and the average was 100 patient visits per chiropractor per week. The smaller Chiropractic Economics salary and expense survey (107 self-selected respondents, so treat it as indicative) describes the typical practice as seeing 138 patients a week and attracting seven new patients a week, with solo practices reporting two employees.

Put those together and the arithmetic is plain. One or two people run the desk, the therapy bay, check-in and check-out for a hundred-plus visits a week, and the phone rings while both of them have their hands full. Those seven new patients a week mostly start as a phone call or a web form. We are not going to quote a statistic for how many chiropractic calls go unanswered, because we could not find one that does not come from a company selling the cure. Your phone system's call log will give you your own number in five minutes, and it is the only one that matters.

What it should handle

• New patient calls. Name, phone number, what brings them in in their own words, how they heard of you, whether they plan to use insurance, and a booked first visit or a firm callback time.
• Reschedules and cancellations. The bulk of call volume in a practice built on repeat visits. Offer the next opening rather than just deleting the slot.
• Factual questions. Hours, address, parking, what to bring, whether you see children, whether you take a named insurance plan - from a sheet you wrote, not from inference.
• Messages for the doctor. Existing patients with a question about their care. Captured verbatim, not answered.
• Accident and injury intake. A caller after a car accident or a work injury is both a higher-value case and a clinical flag. Capture the date, what happened and who is paying, and route it to the doctor rather than into the next free slot.
• After-hours coverage. Evenings and Saturdays are when working patients call. See our after-hours answering guide for the coverage patterns.
• Calls in Spanish. If your community needs it, check how the service actually delivers it (what "bilingual" means in practice).

Seven sentences it must never say

Each of these is something a friendly, well-meaning person on the phone says naturally. Each has a rule or a primary source behind why it does not belong in the script.

New York's Office of the Professions puts the general principle in one sentence in its practice alert on unlicensed individuals: they may do general office work and collect and record patient data, but may not perform "tasks that require professional or clinical judgment". Rules differ by state and the three quoted here are examples, not a survey - your own board's rules are the ones that apply. The point for a phone script is the same everywhere: it records, it books, it routes. Whoever answers is, for this purpose, the least clinically qualified member of your team, whether that is a call-centre agent in another state or a language model.

Red flags are not a booking

Back and neck pain are almost always what they appear to be. A small number of callers describing the same pain have something that should not wait for an appointment, and a script that cheerfully offers them Thursday at 2:30 has failed. The service does not need clinical skill to avoid that. It needs a list, and an instruction to stop.

Emergency: tell the caller to call 911

• Stroke signs. The CDC's list is sudden numbness or weakness in the face, arm or leg, especially on one side; sudden confusion or trouble speaking; sudden trouble seeing; sudden trouble walking, dizziness or loss of balance; and sudden severe headache with no known cause. Its instruction is to call 911 right away.
• Signs of cauda equina syndrome. The American Association of Neurological Surgeons lists red flag symptoms including urinary retention, urinary or fecal incontinence, saddle numbness and weakness in the legs, and states that "immediate medical attention is required" for any of them. It adds that treatment within 48 hours of onset gives a significant advantage in recovery - which is exactly the window a Friday-evening "see you Monday" uses up.
• Back pain with chest pain, or after a serious accident. Both are on the NHS's call-emergency-services list for back pain, alongside numbness or weakness in both legs and loss of feeling around the genitals. The NHS is a UK source; the equivalent in the US is 911 or the emergency department.

Not routine: the chiropractor decides before anything is booked

• A recent accident, fall or other trauma.
• New numbness, tingling or weakness in an arm or leg.
• Pain that is getting rapidly worse, or with fever.
• A new, severe or unusual headache with neck pain. The 2014 American Heart Association and American Stroke Association scientific statement on cervical artery dissection notes that patients with a dissection may present with one-sided headache or pain at the back of the neck, and concludes that "practitioners should strongly consider the possibility of CD as a presenting symptom". The same statement is careful about causation: it says the evidence is insufficient to establish that manipulation causes dissection, while reporting a statistical association. For a phone script the implication is narrow and practical - this caller is the doctor's to assess, not the scheduler's to slot in.
• A patient who feels markedly worse after a visit. Always to the doctor, the same day.

Chiropractors already do this screening in person - in the NBCE survey 82% reported assessing risk factors and possible contraindications to care daily. The answering service's job is simply not to get in the way of it. The mechanics of wiring a call to reach you, then a backup, are in our emergency call escalation guide.

Medicare, insurance and price questions

After "can I get in today", the most common question a new caller asks is some version of "what will it cost me". This is where an untrained answer creates a billing dispute three weeks later.

Medicare

Medicare's coverage is narrower than most patients assume, and the script should be able to say so accurately. Medicare.gov states that Part B covers adjustments of the spine by a chiropractor "to correct a subluxation", that it "doesn't cover other services or tests a chiropractor orders, including X-rays, massage therapy, and acupuncture", and that after the Part B deductible the patient pays 20% of the Medicare-approved amount. The Medicare Benefit Policy Manual adds that chiropractic maintenance therapy "is not considered to be medically reasonable or necessary, and is therefore not payable".

That last line is why a script must never tell a Medicare patient that a visit "is covered". Whether a given visit is active treatment or maintenance is a clinical and documentation question, and it is one Medicare audits: a CMS guidance document for chiropractors reports that a 2024 review found errors in 33.6% of chiropractic claims. The phone is not the place to add to that.

Self-pay and the good faith estimate

Chiropractic has an unusually large cash side - in the NBCE survey, private pay and cash accounted for 41% of reimbursements. That makes one federal rule more relevant here than in most specialties. Under 45 CFR 149.610, providers must inform uninsured or self-pay individuals that a good faith estimate of expected charges is available, and the regulation says that information must be "orally provided when scheduling an item or service or when questions about the cost of items or services occur". Scheduling by phone is exactly that moment, and it is usually your answering service's moment rather than yours.

The timing rules, as CMS summarises them: care scheduled three to nine business days ahead gets an estimate within one business day; care scheduled ten or more business days ahead gets one within three business days; and a patient can ask for one before scheduling. The script does not produce the estimate. It asks whether the caller will be using insurance, says the sentence, and flags the booking so your office sends the document on time.

HIPAA, messages and reminders

• Are you a covered entity? Under 45 CFR 160.103, a health care provider is a covered entity if it "transmits any health information in electronic form in connection with a transaction covered by this subchapter" - in practice, electronic insurance billing. Most chiropractic offices do. A purely cash practice that never bills electronically should ask counsel rather than assume either way.
• The BAA. If you are covered, a service that receives patient names, numbers and reasons for visiting on your behalf fits the definition of a business associate, and 45 CFR 164.502(e) requires the arrangement to be documented in a written contract. Get it before the first forwarded call, and read what it says about recordings and transcripts. Many answering-service pages say "HIPAA compliant" and stop there; the agreement is the thing to ask for.
• Minimum necessary.The same section requires reasonable efforts to limit information to the minimum needed. For a message that means "new patient, low back pain since Saturday, wants this week" - not a medical history.
• Reminder calls and texts.If the service sends reminders for you, the FCC's healthcare exemption at 47 CFR 64.1200(a)(9)(iv) comes with conditions: sent only to the number the patient provided, limited to purposes such as "appointment and exam confirmations and reminders", no telemarketing or billing content, 160 characters or less for a text, at most one message a day and three a week, and an opt-out in every message. A "we miss you - 20% off your next adjustment" text is marketing, and is outside it.

The integration claim to check

Several answering services list ChiroTouch and Jane among their integrations. The software vendors' own pages are more cautious, and where the two disagree the software vendor is the one that controls access.

• Jane. Its integrations FAQ answers the question directly: "No, Jane doesn't currently have an open API or provide API keys." Jane describes an approval-based partner program instead, so an integration is possible only for vendors it has admitted.
• ChiroTouch. Its marketplace page listed the "Scheduling & Intake" category as "Coming Soon!" when we read it on October 1, 2026.

That does not mean every integration claim is false - a vendor may have a private arrangement, or may mean something looser, such as emailing a message that your staff type in. It means the claim needs a demonstration. Ask to watch an appointment appear in your own schedule during the trial. For transparency about our own product: we book into Google Calendar, Outlook and Cal.com, and can send the booking to another system by webhook. We do not write into ChiroTouch, Jane or any other chiropractic practice management system, so with us the appointment reaches your schedule through a synced calendar or through your front desk. If direct write-back is essential, that rules us out and you should know it before the demo. How calendar booking works is in our appointment booking guide.

Live agents vs AI vs hybrid

On cost, live services publish plans from about $149 to $395 a month for 100 minutes, and the invoice depends on how they round call time - we went through the published rate cards in the medical answering service pricing guide. Our own plans are flat and listed on the pricing page. You keep your existing number either way (how call forwarding works).

What good calls sound like

A new patient at 12:40, while the desk is at lunch

The Medicare question

The call that is not a booking

Setting it up

1. Write the two lists first. Emergency, and not-routine. One page, in plain words a caller would use, signed by the chiropractor. Everything else in the setup is secondary to this.
2. Write the fact sheet. Insurance plans accepted, the Medicare paragraph, new-patient fee if you publish one, the good faith estimate sentence, what to bring. The script may say what is on the sheet and nothing beyond it.
3. Add the seven sentences as explicit prohibitions. With a live service, put them in the account instructions. With an AI agent, put them in the prompt as hard rules (how to write receptionist prompts).
4. Sign the BAA before forwarding a single call, if you are a covered entity.
5. Decide where bookings land and prove it. Watch a test appointment arrive in your schedule.
6. Test the three calls above yourself. Especially the third. Call your own line after hours, describe a red-flag symptom in ordinary language, and see what happens. Then check that the alert reached your phone.
7. Read a week of transcripts or listen to recordings. You are looking for one thing: a sentence that sounds like advice.