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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79

u/bzzyy Apr 28 '25

If the office is in network with your insurance, their contract may require them to submit the bill to your insurance.

39

u/Used-Somewhere-8258 Apr 29 '25

This is 100% the correct answer. Once they know you have insurance, they usually can’t just pretend like they don’t know anymore.

4

u/Skippiechic Apr 29 '25

And they can/will use your SSN to find your coverage.

1

u/lpcuut Apr 29 '25

I don’t give out my SSN to doctors offices, I don’t think most people do.

2

u/hbk314 Apr 29 '25

They can likely acquire your SSN if they want to. Most people probably do provide it if the doctors office asks for it.

1

u/Skippiechic Apr 30 '25

Most of them require it in the initial paperwork for billing purposes.

1

u/Key_Employment4536 May 02 '25

You just have marked through that and hand it back to them

1

u/Key_Employment4536 May 02 '25

I work in healthcare privacy. I refuse to give my Social Security number to any doctors office. You do not want to do this. You do not know how bad healthcare cybersecurity, but it is beyond bad. And I will tell them that to their face they have to give me a reason they need it and they’ve never been able to and that includes cosmetic stuff that I pay out-of-pocket

1

u/Key_Employment4536 May 02 '25

Yes, they can. If I go to my doctor that I’ve be going to for years tomorrow and tell him I do not want the treatment for this condition to be sent to my insurance company they have to abide by that

now they can force me to figure out how I’m planning to pay for it standing right there, but they cannot tell me that they have to send it to an insurance company

1

u/Key_Employment4536 May 02 '25

The contract with the doctors office cannot oversee override the federal privacy law