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/bmfitz Apr 29 '25

I accept insurance for behavioral health and I can still accept cash pay. As far as I know no one can force someone to use their insurance or a provider to bill it if the client requests to pay out of pocket. The only thing that would be a breach of my contract [specifically] would be if I refused to take their insurance and would only accept cash pay. The only caveat is that if someone pays out of pocket lower than the contracted rate it can’t go towards a deductible or out of pocket costs. I can’t vouch for other insurance contracts though, only mine.