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/dadayaka Apr 29 '25

While not illegal, it may be against their contract with the insurance. Medicare and Medicaid contracted providers are almost all prohibited from taking cash patients who have those insurance plans. Since those are government funded insurance it can be seen as illegal (though I dont know if thats the right word to use).

Other insurance plans may have contracts that dictate the same stipulation and could cause the insurance to stop working with that provider. If its a big insurance network they will do (and often say) almost anything to stay compliant with that contract or face loosing thousands of patients.

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u/Key_Employment4536 May 02 '25

If I have signed the contract that says they have to break a federal law then there are so stupid you probably should not be receiving medical treatment from them.