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/InterestingFlight725 Apr 29 '25

I had something like this happen recently to me. If you tell the hospital that you're going to self pay before the procedure (before insurance is billed), they are required to honor this under the HITECH Act of 2009 (Google it if you don't believe me). It's basically protecting you as the patient from having your PHI released to insurance, which is protected also by HIPAA. This is assuming you're in the USA.