Wiki In Network Provider making Certain service cash only

[honeybee]

I was wondering if a provider who is in network with an insurance plan can refuse to bill and make a patient pay cash for certain services. This particular doctor provides Suboxone treatment (basically an office visit in order to write an RX for the meds each month for the patient) and its usually covered with most insurance plans just like any other office visit is since E/M codes are billed but the doctor is now refusing to take insurance and is making all those patients pay a cash rate out of pocket. $100 for follow up and $200 for new evals. Typically 99213, 99214 is commonly billed for these visits. Can the doctor do this?

 

[CodingKing]

If you are a participating provider and its a covered service under the insurance, you would need to submit to insurance and not collect anything outside the patients cost share (copay, deductible, coinsurance etc). You may want to ask the payer and see what they say, more likely than not it will be a contractual violation. I actually find it funny, we had a few doctors that were banging down our door trying to get contracted so they could be reimbursed for suboxone treatment.