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/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.

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

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u/[deleted] Apr 29 '25

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u/HealthInsurance-ModTeam Apr 29 '25

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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.

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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