Wiki Can insured clients decide not to use their insurance?

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charbanc

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Hello,

I work for a non-profit and we are contracted with several commercial insurances. Some clients do not want to use their insurance because they have a high deductible or high co-pay and would rather pay out of pocket. My question is can we allow them to be private pay even though we know they have insurance that we are contracted with?
 
As long as they are aware by getting a self pay discount they cannot get credit towards their deductible. I'd get them to sign a document stating that.
 
CodingKing said:
As long as they are aware by getting a self pay discount they cannot get credit towards their deductible. I'd get them to sign a document stating that.
Click to expand...

Thank you for your response. Are we in violation of our contracts with health plans if we allow them to be self pay instead of using their insurance?
 
No. The law says you can have a service and ask that it not go to your insurance if you pay for it yourself. Meaning you cannot report it to the insurance company at any time if they request records either.
 
The problem is that you are offering a lower charge for the same service that charge higher for the insured. You are in fact giving an incentive to not have insurance. Or to have cheap insurance with a high deductible. Some states have specific state laws that prohibit separate self pay rates.
 
I am in California.
We accept cash pay from patients that have commercial insurance.
The only exceptions are Medi-Cal (Medicaid) and Workers Compensation.
If provider(s) are contracted with Medi-Cal (Medicaid), the patient cannot cash pay and the provider cannot accept cash pay from the patient.
Patients with Workers Compensation claims cannot pay out of pocket for medical care. Providers cannot charge the patients for medical care.
 
charbanc said:
Hello,

I work for a non-profit and we are contracted with several commercial insurances. Some clients do not want to use their insurance because they have a high deductible or high co-pay and would rather pay out of pocket. My question is can we allow them to be private pay even though we know they have insurance that we are contracted with?
Click to expand...

I don't have your answer but I am seeing a lot of comments regarding giving the patient a discounted rate. I am not seeing where you mentioned what you are charging the patient... Are you billing them at self pay the same rate you would bill insurance?

I'm sure you will get a lot of great advice here :)
 
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