Payments > Patient Billing

Cash pay for insured patients

(1/2) > >>

Snail9778:
Is it illegal to let a patient with insurance from the healthcare exchange pay cash for services rendered? We would not be in network.

rdmoore2003:
I would check with their insurance to verify whether or not they have out of network benefits before I did anything else.

PMRNC:

--- Quote ---Is it illegal to let a patient with insurance from the healthcare exchange pay cash for services rendered? We would not be in network.
--- End quote ---

No, in fact many patients with a subsidized plan on the exchange market have high dollar deductibles/out of pocket. Those patients should be paying up front, you can still bill insurance so that the out of pocket gets credited to them but you don't want to cash discount the patient unless you send the same discount to the insurance company. Now if the patient just doesn't want the claim to go to insurance at all due to whatever reason.. I have them sign a waiver so they understand there insurance will not be billed. If the client gives them cash discount, the waiver will let the patient know that their bill was not sent to insurance and that they understand if they want to file with insurance they can do so with an itemized bill that shows the actual cost and discount.

Snail9778:
The patient wanted to pay as a cash pay patient because he did not want any other doctor to do his cataract surgery and he did not want to wait. We were fine with letting the patient pay as a cash pay, but the ASC(who is also out of network) refuses to do the surgery as long as the patient has insurance. That is who told me it was illegal and considered insurance fraud to give a cash pay discount to an insured patient. We were just curious after being told this.

shanbull:
It would be illegal to first bill the insurance and then not bill the patient for the remaining portion, or to bill the patient for a portion of the unpaid insurance payment that you were contractually obligated to adjust. But not billing the insurance at all is ok if the patient wants to pay cash only. Just have the waiver signed like Linda said just in case the patient changes his mind later and does want to bill his insurance.

Basically, the legal options are either cash only OR insurance, but no mix of the two. There is no fraud going on if the patient wants to pay cash only and not involve insurance period. Giving a cash discount is also fine as long as insurance is not involved. I think that's where the confusion is for the ASC.

Navigation

[0] Message Index

[#] Next page