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/OneLessDay517 Apr 29 '25

If you presented your insurance to them and they are in-network, it would violate their contract to not send it through insurance. It's not illegal, she used the wrong terminology.

If you want to avoid using your insurance, then don't present your card. But by self-paying, you will NEVER hit your deductible. If you have a large expense, you're still going to have to pay that full deductible before insurance kicks in.