is it legal to offer self pay to insured patients?

if a patient HAS medical insurance but has a high deductible, is it legal for a medical facility to offer them a self-pay rate (as if they don't have medical insurance) because it will be cheaper for the patient? i heard that if the government or whoever finds out that the patient actually has insurance, its trouble for both the patient and the facility. anyone know?

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  • 10 years ago
    Best Answer

    Yes, it's legal. I paid for some lab work independent of my insurance company because I was seeing a plastic surgeon for cosmetic surgery, and surgery for cosmetic reasons is not covered by your medical insurance anyway.

    There IS a risk that comes with submitting your medical bills to your medical insurance company. If they discover something in your medical records [and they are entitled to read them because you have to grant them written permission to do so] that suggests a potentially costly medical problem to them, then you might be dubbed as having a "pre-existing condition." This makes it difficult for you to get insurance from a new insurer should you switch jobs or retire before age 65 or 66 (at which time Medicare can take you on). I've also heard that some insurance companies can cancel your insurance with them, no matter how long you've held it with them, if you are diagnosed with one of a certain number of diseases.

    If you deal with a doctor outside of your insurance (and thus do NOT give your doctor permission to send your bills to your insurance company) then the insurance company will never even find out what kind of medical bills you incurred because they can't invade your privacy.

  • 10 years ago

    it's legal.

    however, the problem arises when the patient doesn't pay upfront and is billed...and then they can't afford to pay the bill, so the medical facility tries to bill the insurance company -which ends up being denied, because the insurance company didn't approve of the service in the first place, or it's past the time in which the claim must be submitted...and then the facility ends up with no money, and the patient ends up with bad credit.

    Source(s): risk management advisor - 15yrs
  • Flower
    Lv 7
    10 years ago

    No, there is nothing wrong with the patient paying in cash at the time of treatment, and not billing the insurance company. Make sure the doctor's office does not bill insurance as well. Most people would do that if they could afford it. You can always pay cash directly at the time of treatment.

  • 10 years ago

    Yes, but then that doesn't go towards the deductible.

    Keep in mind, even if they have that big fat deductible, they get CHARGED based on the discounted, negotiated rate that the insurance company would pay.

    So it USUALLY makes more sense, to not do it "self pay". The insurance negotiated rate is usually LESS than self pay.

    • Anthony6 years agoReport

      The insurance negotiated rate is usually the highest rates that you will pay for most routine doctor visits. Medicaid rates are the cheapest, then Self-pay then insurance 'negotiated rates.' Hospitals get the most money from insurance, then self-pay

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  • Anonymous
    10 years ago

    It is perfectly legal as long as the medical facility doesn't try to bill the insurance company too.

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