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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4

u/WorryFar7682 Apr 29 '25

Work in healthcare. Not illegal.

5

u/Particular-School-15 Apr 29 '25

This is the correct answer. You can opt out of having your insurance billed and pay cash

2

u/ResearchWise3593 Apr 29 '25

All depending on the policy and contracts of the individual clinic/system.

I work in a system that does not allow self pay if there is insurance to bill.

I do work in family medicine though, so there are limited procedures, and most patients insurances cover primary care prior to hitting the deductible

1

u/Alaskadan1a Apr 29 '25

But in most cases, if you pay cash and opt out, then it does not go toward your deductible. So eventually, if you actually had substantial bills, you’d still have to pay down your deductible before your insurance would start covering the next part.