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.

86 Upvotes

86% Upvoted

163 comments sorted by

View all comments

Show parent comments

3

u/RockeeRoad5555 Apr 28 '25

Some provider/insurance contracts may preclude this but it is only illegal for Medicaid.

-1

u/LuluGarou11 Apr 29 '25

Not illegal for medicaid either.

2

u/RockeeRoad5555 Apr 29 '25

Probably varies by state.

-1

u/LuluGarou11 Apr 29 '25

Nope. It does not. It is not illegal.

2

u/RockeeRoad5555 Apr 29 '25

If the provider participates in Medicaid, it is.

1

u/LuluGarou11 Apr 29 '25

You are mistaken.

3

u/RockeeRoad5555 Apr 29 '25

I would advise anyone reading this to do their own research and not trust either one of two arguing commenters on Reddit, neither of whom are providing sources.

0

u/LuluGarou11 Apr 29 '25

You are spreading misinformation. 

2

u/RockeeRoad5555 Apr 29 '25

Anyone reading this, please do your own research.

1

u/CapnLazerz Apr 29 '25

No need to argue, the answer is straightforward. The HITECH law has a provision that allows a patient to opt out of using their insurance for privacy reasons. Offices should have a form to this effect and patients don’t have to disclose the reason why they don’t want to use their insurance.

Providers enrolled in Medicare cannot do this. Medicaid providers may be able to do this depending on the State’s rules.

1

u/RockeeRoad5555 Apr 29 '25

Depending on the state rules. Thank you.

→ More replies (0)

1

u/Alternative-Sweet-25 Apr 29 '25

Not illegal per se but it does violate the contract with Medicaid and the patient can be kicked off.

1

u/LuluGarou11 Apr 29 '25

That is not true. 

1

u/Alternative-Sweet-25 Apr 29 '25

Yes it 10000% is true.

0

u/[deleted] Apr 29 '25

[removed] — view removed comment

1

u/[deleted] Apr 29 '25

[removed] — view removed comment

1

u/HealthInsurance-ModTeam Apr 29 '25

Your post may have been removed for the following reason(s):

**Please be kind to one another, and comment in good faith. It's imperative this community is a welcoming space to all.

There's zero tolerance for hatred, malice, or threats of violence**

  • Rule 5

Do not reach out to a moderator personally, and do not reply to this message as a comment.

You can review the community rules here.

1

u/HealthInsurance-ModTeam Apr 29 '25

Your post may have been removed for the following reason(s):

**Please be kind to one another, and comment in good faith. It's imperative this community is a welcoming space to all.

There's zero tolerance for hatred, malice, or threats of violence**

  • Rule 5

Do not reach out to a moderator personally, and do not reply to this message as a comment.

You can review the community rules here.

1

u/Weeping_Willow_Wonka Apr 29 '25

More likely the provider would get kicked off than the patient, the patient doesn’t have a “contract” per se with Medicaid but the provider certainly does. The type of fraud that might cause a patient to be kicked off is more like let a neighbor use their Medicaid card to go to urgent care or something