Illegal to not bill through insurance?

[u/MenuRare9880]

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.

[u/MenuRare9880 → u/[deleted]]

I am not. This is helpful thank you!

[u/Working_Coat5193 → u/[deleted]]

Medicare providers have to opt out of Medicare. It is illegal to charge a Medicare patient without running it through the program.

[u/LuluGarou11 → u/[deleted]]

Even Medicaid patients can self pay. It is not illegal.

[u/999cranberries → u/LuluGarou11]

It's not criminal but it is often a violation of the provider's contract with the state and the contract the patient enters into when they enroll as well. So in that sense there can be legal consequences.

[u/LuluGarou11 → u/999cranberries]

Either way, you concede it is not in fact "illegal."

[u/LuluGarou11 → u/999cranberries]

No that is a misunderstanding of the contract.

[u/LuluGarou11 → u/[deleted]]

Gtfo with your nonsense. It is not illegal in any state much less many states. If your practice is so greedy as to refuse self pay pts thats on you.

[u/LuluGarou11 → u/[deleted]]

It means legally codified. Wtf does it mean to you? A whim?

[u/Spirited_Concept4972 → u/LuluGarou11]

No, they cannot.