Insurance -vs- self pay

[justasking]

As a provider we have contracts with many carriers. We have some patients that do not want us to file their insurance they rather be treated as self pay.

I have always understood that if we as a provider have a contract with the patients insurance company the services must be billed.

Also I was told that in February a new HIPAA law went into effect that states the patient has the right to pay in full for expenses for health care services and request that your practice not disclose his or hers medical information to the health insurance company.

Thank you in advance!

[oneround]

Thursday, February 18, 2010, a new restriction on disclosure of protected health information went into effect that impacts Covered Entity health care providers.  According to Section 13405 of Subtitle D of the HITECH Act (42 USC 17935), a health care provider must honor a patient request to restrict disclosure of protected health information to a health plan for purposes other than carrying out treatment (namely, payment or health care operations) if the patient pays the health care provider out of pocket in full.

[PMRNC]

That's correct, but it is in best interest of the practice to get a waiver signed so that the patient understands the practice is NOT responsible if the patient goes to the carrier in the future. That happens a lot, patients will tell the provider they don't want to use their insurance, pay in full and then turn in the bills later to get reimbursement for what ever the circumstances are. Mental health providers use these a lot. I have a few clients who have some high profile patients who do not want to go through insurance, we have a waiver done up where the patient signs it to cover ourselves.