Section 13405(a) of the
Hitech Act speaks to the individual's ability to request that PHI not be disclosed when paid out of pocket in full. The
Federal Registry on page 5626 discusses this further by stating, "We stated that we interpret section 13405(a) as giving the individual a right to determine for which health care items or services the individual wishes to pay out of pocket and restrict.." Also in the same Federal Registry, "With respect to Medicare, it is our understanding that when a physician or supplier furnishes a service that is covered by Medicare, then it is subject to the mandatory claim submission provisions of section 1848(g)(4) of the Social Security Act (the Act), which requires that if a physician or supplier charges or attempts to charge a beneficiary any remuneration for a service that is covered by Medicare, then the physician or supplier must submit a claim to Medicare. However, there is an exception to this rule where a beneficiary (or the beneficiary’s legal representative) refuses, of his/her own free will, to authorize the submission of a bill to Medicare. In such cases, a Medicare provider is not required to submit a claim to Medicare for the covered service and may accept an out of pocket payment for the service from the beneficiary." There is much more in the registry than what I've quoted.
Professionally, I would have a form available for the patient to sign attesting that they desire for insurance to NOT be billed for the service rendered. This further protects you if the patient goes off and seeks compensation from insurance by filing the claim directly with the insurance.