Author Topic: Cash pay for insured patients  (Read 2462 times)

Snail9778

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Cash pay for insured patients
« on: June 23, 2014, 10:27:58 AM »
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

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Re: Cash pay for insured patients
« Reply #1 on: June 23, 2014, 04:01:41 PM »
I would check with their insurance to verify whether or not they have out of network benefits before I did anything else.
Regina

PMRNC

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Re: Cash pay for insured patients
« Reply #2 on: June 23, 2014, 04:01:50 PM »
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.

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.
Linda Walker
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Snail9778

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Re: Cash pay for insured patients
« Reply #3 on: June 23, 2014, 04:35:52 PM »
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

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Re: Cash pay for insured patients
« Reply #4 on: June 23, 2014, 05:04:20 PM »
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.
« Last Edit: June 23, 2014, 05:08:16 PM by shanbull »

PMRNC

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Re: Cash pay for insured patients
« Reply #5 on: June 23, 2014, 05:11:11 PM »
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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.

Your initial post left a lot of important info out, so I'm going to revamp my answer.  The ASC has every right to question billing practices for the surgeon's who operate in their facility. IF the patient has out of network benefits, the insurance company may or may not have responsibility to pay the claim. You don't mention that the patient is willing to pay the ASC in cash. If they bill on an AOB the surgeon's records/op report can be requested. It will raise a red flag to the insurance company. If you are going to let patient pay in cash, that is fine, paying in cash should NOT move the patient's surgery UP at all. I hope that is not a factor in your office, as that could land you in a lot of trouble with that alone. I would have to really ask WHY the patient doesn't want the insurance billed? If they have insurance and they pay their out of pocket up front, great. Since the ASC is refusing, I'm thinking that the patient may have out of network benefits to which they can bill and I'm guessing the patient hasn't offered to pay them up front. Don't forget your dealing with a surgical procedure to which you really can't guess costs for anything extra (problems that might arise).

There's a few fine lines here, but the bottom line is that the ASC does indeed have right to question billing practices if they are billing insurance. And if there are any cash discounts being made they must be reflected IN all the billing done to the insurance carrier.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com