# Insurance vs Self pay question



## laurijean (Mar 12, 2015)

If a person has Insurance and they choose to self pay for a procedure because they have a high deductible and the self pay rate is less then the contracted rate with the Insurance company, is this legal for the providers office to except the self pay and not bill the Insurance?


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## mitchellde (Mar 12, 2015)

No.. You should not have a self pay rate that is less than what you represent to the payer for that service.  You agree to accept less than your stated fee schedule in exchange for acess to the payers patient base. This is agreed to and contracted prior to your seeing the patient.  If you are contracted with the carrier then you have an obligation to bill the services.  The patient has the obligation to bay the deductible.  Now how can this hurt?  
Let's say you did allow the patient to pay out of pocket the lower rate.  Now down the road something else happens and they have to pay for another surgery and still must meet the deductible, but they say I already paid x dollars out of pocket for that surgery two months ago.  Oh but the payer does not know this as it was not billed to them.  You see this just sets up too many future problems.


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## JesseL (Mar 12, 2015)

is it okay to bill the insurance less than the fee schedule?


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## laurijean (Mar 18, 2015)

Thank you


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## j.monday7814 (Mar 18, 2015)

patients can pay out of pocket for services even if they have insurance but (like state in an earlier post) they must pay the same amount as their insurance contracted rate. The only real motivation they should have paying for something out of pocket is if they are testing or treating for something that they don't want their insurance to know about.

paying self-pay because they have a high deductible just doesn't make financial sense.


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