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/positivelycat Apr 28 '25 edited Apr 29 '25

Not illegal but many view it as a violation of the insurance contract.

Now they can not bill your insurance but they do not have to offer you the cash rate and can bill you the full insurance rate.

They would also likely require you sign something prior to service that says you will not bill insurance.

That is were the fraud/ dishonest part comes in some patients have been know to try and pay self pay rate then turn around and bill insurance or cry wolf 8 months layer that they should have billed insurance...

We won't do it cause to many people try to bill there insurance or claim we should have and then we get in a pickle with insurance.

Edit also we may find your insurance especially if we already have it..

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u/MenuRare9880 Apr 29 '25

shit so even if i go to a new Dr who I don’t provide my insurance to, they can still find my policy??

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u/LuluGarou11 Apr 29 '25

Please disregard these people telling you you cannot self pay. They are very wrong. 

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u/NoMagazine9243 Apr 29 '25

Humbly, you are correct as it relates to private and commercial insurance. You may even be correct RE Medicare, but Medicaid is different. If a person is on Medicaid (or discloses to a provider that they are on Medicaid), some providers are restricted from knowingly providing any services to that person, including for cash (eg MIDI is a good example). I’m only a consumer and do not work in healthcare or insurance, but I’m absolutely certain the rules are different for Medicaid as a gov’t funded program.