Wiki non-contracted insurance plans

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jebond123

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A patient of ours recently changed her insurance to Impact Health Sharing which we are not contracted with. I told her we would see her as a cash patient and then
provide her with a detailed receipt for her to submit to her insurance company. I am now getting push back from her insurance agent. He states that according to HIPAA law, I am
legally obligated to submit a claim for her regardless of whether or not we are contracted with the insurance company. Is this true?
Much appreciate any advice.
Janet
 
jebond123 said:
A patient of ours recently changed her insurance to Impact Health Sharing which we are not contracted with. I told her we would see her as a cash patient and then
provide her with a detailed receipt for her to submit to her insurance company. I am now getting push back from her insurance agent. He states that according to HIPAA law, I am
legally obligated to submit a claim for her regardless of whether or not we are contracted with the insurance company. Is this true?
Much appreciate any advice.
Janet
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Well, first of all, Impact Health Sharing is not insurance. It is a cost-sharing program that markets itself as an alternative to health insurance.

Impact Health Sharing states on the website that patients can self-pay and submit for reimbursement:


STEPS TO SHARING
When you get medical care with Impact Health Sharing, your doctor may bill Impact directly or ask you to self-pay.

Whether you submit your bills for sharing directly to Impact or your provider submits them to us, you are still saving with Impact and seeing the provider you choose.

In the end, whether your doctor bills Impact directly or you pay first, your medical needs can be shared through Impact Health Sharing, as long as your costs are eligible for sharing and your PRA is met. Both methods are just different ways to handle payment.
 
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