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/devanclara Apr 29 '25

Since they are claiming it's "illegal" I would ask them to site which statute it violates.

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u/Emotional_Wheel_7140 May 02 '25

It’s a violation with their contract with their insurance. If patient shows their insurance and the office runs it. They cannot as an office not now abide by the insurance contract. It’s called insurance fraud.

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u/Anxious_Win7381 May 02 '25

Odd, because I was in physical therapy, using Medicaid and whenever I checked in using MyChart it gave me an option to not use my insurance. Hubby has his PCP in the same network and it asks the same thing, and he's on Medicare. We laugh about it every time we see it, because why would we want to be billed without our insurance? Ohio, BTW.

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u/Emotional_Wheel_7140 May 02 '25

Weird …”Medicaid recipients always have the option to self-pay for services not covered, but they cannot self-pay for services that healthcare coverage will pay for. In other words, this gets to the heart of the issue: You can't self-pay for a service that Medicaid will cover”