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/lemonlegs2 Apr 28 '25

Wow. I can't believe they told you that. It is very legal. Majority of my life I've done cash pay because I have crappy insurance. Most doctors will not back a bill out after it's been submitted to insurance. But for future visits, either tell them you lost your insurance or if they have a better billing person tell them to denote as self pay.

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u/sicnevol Apr 29 '25

It’s not legal if it’s Medicare or Medicaid. They have billing contracts.

1

u/lemonlegs2 Apr 29 '25

My understanding is majority of people on those programs do not have deductibles, definitely not 3.5k deductibles. Hence the assumption it is private insurance.

1

u/sicnevol Apr 29 '25

Depends on the state. Some people have monthly spend downs, but not deductibles.