Author Topic: I have a patient that doesn't want to use their insurance, is that legal?  (Read 1342 times)

juliemac713

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I have a patient that has insurance, but does not want to use it.  They want to be self pay for their visit.  We were told that this is against the insurance contract.  Is this legal?

kristin

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Yes, they can choose to not use their insurance, that is their right.

PMRNC

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HIPAA allows patients the choice to have to disclose PHI so they have a right to not bill insurance. What you do have to do though is make sure if you are providing any type of cash pay discount it is showed on the itemized bill you give the patient JUST in case they file it later with their health plan. Your bill should reflect the same charges as it would if you billed their insurance and show any discount you provide.

Linda Walker
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juliemac713

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Thank you for your responses.  Then the next question that I have, is..  If a patient opts out of using their insurance, should I have some sort of waiver for them to sign and does anyone have a sample that they use?

Michele

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I am not sure if there is a law addressing this but I know I would personally want something written down just to make sure the patient didn't come back later and say that they didn't tell you not to bill their insurance.  Just something simple like "I am choosing to pay directly for these services." 
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PMRNC

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Quote
I am not sure if there is a law addressing this but I know I would personally want something written down just to make sure the patient didn't come back later and say that they didn't tell you not to bill their insurance.  Just something simple like "I am choosing to pay directly for these services."

So long as the bill given to the patient matches what would have been billed to insurance, this wouldn't be an issue. HIPAA allows a patient to choose to not have their insurance billed by the provider. If a provider gives a cash discount, they give the bill to the patient to show the actual charge and the discount and paid amount. That's all the provider's office has to do. It is however a good idea for network contracted providers to have patient sign a waiver that the provider isn't responsible if patient should decide later to be reimbursed from their health plan.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

juliemac713

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Does any one have a copy or sample of the waiver that they have their patient's sign that they could send to me?
j.mccarthy@advancedorthospine.com

Thank you so much for all the help.

Michele

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I emailed you.  :)
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