r/HealthInsurance • u/MenuRare9880 • Apr 28 '25

Claims/Providers Illegal to not bill through insurance?

I just got insurance for the first time in 3 years. My treatment that cost me $190 cash (self-pay) is now $520 until I meet my $3,500 deductible which would take me 11 months, soo.. pointless.

I told my Dr’s office I am no longer going to go through my insurance & the billing lady said that’s illegal… I am going to look for a new Dr now anyway but is there truth to this? Would I face repercussions as an individual patient if I simply chose not to disclose that I have insurance & pay the cash price?

FYI: the self-pay price was NOT subsidized by a grant or aid.

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u/lemonlegs2 Apr 28 '25

Wow. I can't believe they told you that. It is very legal. Majority of my life I've done cash pay because I have crappy insurance. Most doctors will not back a bill out after it's been submitted to insurance. But for future visits, either tell them you lost your insurance or if they have a better billing person tell them to denote as self pay.

1

u/sicnevol Apr 29 '25

It’s not legal if it’s Medicare or Medicaid. They have billing contracts.

1

u/lemonlegs2 Apr 29 '25

My understanding is majority of people on those programs do not have deductibles, definitely not 3.5k deductibles. Hence the assumption it is private insurance.

1

u/sicnevol Apr 29 '25

Depends on the state. Some people have monthly spend downs, but not deductibles.

1

u/MenuRare9880 Apr 28 '25

I understand them not being able to back the bill out & I’m willing to pay the $520 this one time. But they would not let me go back to self-pay knowing my insurance is still active 😞

2

u/Particular-School-15 Apr 29 '25

That is also correct once the claim has been submitted you are bound to that process. However moving forward you can choose to not use your insurance. I always ask what the cash price is

1

u/lemonlegs2 Apr 29 '25

That's dumb. Either it's an extremely shady practice, or a very uneducated billing person. The latter is the norm. I'm not sure how medical admin staff are selected..

1

u/DazzlingPen5460 Apr 29 '25

You should call them and say that you would like to report that your insurance is no longer active and to ask them to remove your insurance information from the system. Say that you will not disclose any further information about your insurance status per HIPAA's protection of patients from being forced to disclose insurance status, and if you want to play hard-ball, just let them know that if they want to prod here you're happy to file an investigative req into their office with the Office of the Inspector General (who investigates HIPAA violations)