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/WorryFar7682 Apr 29 '25

Work in healthcare. Not illegal.

4

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