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/LuluGarou11 Apr 29 '25

You are straight up wrong. This is frequently done. ACA even set provisions in place to protect people from misinformed people like yourself denying them their rights. Sorry you suck at your job.

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u/Alternative-Sweet-25 Apr 29 '25

If I’m so wrong prove it.

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u/LuluGarou11 Apr 29 '25

Burden of proof is on you to prove its illegal. You cant. Many different laws protect patients here. One such being the HITECH amendment to ACA. Its not unusual for greedy billing departments to pretend their preference is the law. Do better.

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u/positivelycat Apr 29 '25

The hitech act does allow you to not bill insurance but it also allows the provider to collect full fees upfront and not offer the self pay discount

Which defeats OP purpose.

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u/LuluGarou11 Apr 29 '25

As per the title, OP wanted to understand if it was “illegal to not bill through insurance?”

Thus my point that self pay is an option. And certainly not illegal as so very many suggest on here.

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u/positivelycat Apr 29 '25

Okay but this comment was under the thread where I explained its not illegal but all the other things. I thought this thread moved on from illegal. You commented on a comment not

This thread moved on from illegal to other concerns and consequences.

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u/LuluGarou11 Apr 29 '25

Lol change the goalposts much…

Perhaps you didn’t mean to reply to me to begin with? 

If you did in fact mean to reply to me and derail this comment thread: Maybe try policing someone else. You literally inserted yourself into comments discussing legality on this one. 

Many misconceptions about legality here (not to mention many assuming Medicaid patients have less rights than anyone else). 

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u/positivelycat Apr 29 '25 edited Apr 29 '25

The parents comment is ..mine.. you add yourself to my convo hun

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u/LuluGarou11 Apr 29 '25

Definitely didn’t… hun 🥴. May want to hit the single comment thread button a few times. 

I replied to someone else entirely and then you tried to change the subject. Shame you can’t channel the pedantry into correcting this person spouting bs about supposed illegality. 

https://www.reddit.com/r/HealthInsurance/comments/1ka9vfn/comment/mpl56v5/?utm_source=share&utm_medium=mweb3x&utm_name=mweb3xcss&utm_term=1&utm_content=share_button

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u/positivelycat Apr 29 '25

When I hit it to parent comment till you can go no further it is me saying staring with no not illegal but...

I understand your point cause it's not illegal but has other areas of concern your not adding to the conversation. Nowhere in this thread did anyone but you say the word illegal expect me at the start

You responded to a comment where someone said I was correct again where we said not illegal but different issues and concerns

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u/LuluGarou11 Apr 29 '25

Lol okay whatever you need to say. 

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