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 asked us to document differently. It also isn’t part of the note standards Medicare itself uses. From that alone, they came asking for almost half a million dollars.
We didn’t just pay it. After about a year working alongside our attorney, we got to the real number: roughly $15,000, plus a corrective plan. We did it, and we did it right.
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. They had never asked for it, and it isn’t how these notes are standardly kept. That unpaid year is what forced us to sell two of our offices to keep the rest of the practice alive.
I’ve since reported Highmark to the Pennsylvania Insurance Department, and I’ll be straight with you: this isn’t over. Their demand has climbed from around $430,000 to more than $2 million, and we are still standing in that fight today.
I’m not telling you this to make you angry at anyone. I’m telling you because you asked me to be straight — and because it’s the whole reason the rest of this page exists.
Losing that contract stung. But it forced me to look at something I’d been avoiding: 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.