Illegal to not bill through insurance?

[u/MenuRare9880]

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.

[u/Key_Employment4536]

Sam, I got your legal degree from the Holiday Inn express last night didn’t you

Is other people who have worked in the healthcare industry have pointed out, but some of you were posting about the contracts, and the law is wrong.

The law of governance is HIPAA and it says if you tell them to bill you directly, they have to do that. if you tell them, you don’t want your family member your insurance company or anybody else to know about you treatments They have to do that. They’re not going to do this because it’s going to cost them money not because it’s illegal. They’re making a lot more money off the combination of the insurance and the co-pay then they were the self-pay discount they were giving this person. And no now that they know you have insurance, they’re not going back to giving you the self-pay discount so your options are suck it up or find another provider. and pay it out of your pocket

Now, if you tell them, you don’t want to bill insurance they are within their rights to tell you you have to pay upfront or provide another method to guarantee payment. For example, we did this with a car accident and I had to give them a credit card they could charge if my car insurance company did not pay

The original poster can tell this doctors office that you are going to report them to the office of civil rights at the Department of health and human services for a violation of your HIPAA rights if they continue to bill your insurance company as you have asked them not to provide that information to that entity. That is allowable. Unfortunately you cannot force them to go back to that great deal you were getting before so you’re probably going to wind up paying the whole amount out of pocket, including what the insurance company is currently paying and your current co-pay so make sure you want to do that before you make this announcement. They don’t have to give you that self-pay discount they’ve been giving you.

And having worked on both sides of the table, the insurance company doesn’t really care. They would just assume you kept paying $190 and they never saw a claim but …. and the insurance company is not having your MD sign a contract that puts both the MD and them in violation of a federal regulation.

Here’s a short resource, but there’s an entire collection of

https://www.aao.org/practice-management/news-detail/patient-chooses-not-to-bill-insurance#:~:text=Answer:,subject%20to%20Surprise%20Billing%20regulations.