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.

86 Upvotes

86% Upvoted

163 comments sorted by

View all comments

2

u/NoMagazine9243 Apr 29 '25

Just fyi—this is important to understand/realize if/when you choose to seek out select imaging to proactively manage your own health (eg DEXA bone density, DEXA body comp, CAC ie coronary artery calcium). If you approach imaging center and advise them that you do not have commercial insurance, you can usually negotiate a fantastic cash pay rate. ***For example, for the CAC—under my plan, the test was considered an “advanced image” so my in-network co-pay was $400! Without insurance, the imaging center offered the scan for between $89-99! I paid $99. I was offered a similar price for a DEXA bone scan and $60 for body comp. The important part is not to disclose that you have commercial insurance of any kind, otherwise, the imaging center will insist on billing your plan regardless of whether they are in or out of network (in my experience).

1

u/lemonlegs2 Apr 29 '25

Yeah I had an mri done a few years ago. Cash pay was 250, insurance negotiated rate was 3k. Called many places.