Wiki Self Pay Candida and treatment

[kimid422]

Can a practice bill a patient with insurance as a self pay patient for the treatment of warts with candida, and not bill the charges to the insurance? Any info would be greatly appreciated.

 

[JesseL]

Can a practice bill a patient with insurance as a self pay patient for the treatment of warts with candida, and not bill the charges to the insurance? Any info would be greatly appreciated.

This is based on my own research.

From what I know, the patient will have to sign a form that states that the patient does not want the insurance to be billed. BUT you have to charge the patient the same rate you charge all insurances for services rendered. The only time you can charge a patient a discounted rate is if they are truly "self pay" and without insurance.

If you just charge the patient a different rate from what you charge insurances without submitting the claim to their insurance, it would be under the table and breach of insurance contracts.

Some people also say that it's not legal all together to not bill the insurance because you're hiding the patient's health status from the insurance.

Honestly it's best to consult a lawyer about this to see if you are breaching any contracts or breaking any laws.

 

[ellzeycoding]

Disagree. According the the HIPAA/HITEZCH Omnibus rules, the patient has the right to restrict their protected health information (PHI) from being released to their own insurance company.

The patient can request that you not file insurance, and pay cash, if they request it in righting. They must pay in full, at the time of service, and they can pay the regular rate.

Incidentally, they can also pay a slight discount as a 'prompt pay'. This prompt pay discount is permissible, as long as you allow any patient, without discrimination, the same opportunity for a prompt pay discount.

Here is some information on HIPAA Omnibus rule...

https://www.aapc.com/blog/22440-know-when-hitech-trumps-payer-contracts/

 

[JesseL]

Disagree. According the the HIPAA/HITEZCH Omnibus rules, the patient has the right to restrict their protected health information (PHI) from being released to their own insurance company.

The patient can request that you not file insurance, and pay cash, if they request it in righting. They must pay in full, at the time of service, and they can pay the regular rate.

Incidentally, they can also pay a slight discount as a 'prompt pay'. This prompt pay discount is permissible, as long as you allow any patient, without discrimination, the same opportunity for a prompt pay discount.

Here is some information on HIPAA Omnibus rule...

https://www.aapc.com/blog/22440-know-when-hitech-trumps-payer-contracts/

We can't do this if we're in-network with the insurance though right? What's the standard discount for prompt pay?

 

[cgaston]

It's pretty black and white that the patient can decide not to have something billed to their insurance company even if you participate:


Individuals have the right to request a restriction on uses and disclosure of their PHI. Typical requests include asking the Covered Component to not share any or all information with a family member or friend of the Individual, which should be granted in most circumstances. The Covered Component should endeavor to accommodate all reasonable requests, but should not agree to a restriction if it is not feasible to comply with it.

An Individual may make a request for a restriction either in writing or orally. If an oral request is made, the Covered Component should document the request in the medical record. A form is available for requesting the restriction, but its use is optional. The Individual does not need to explain the reason for the request.

HIPAA recognizes that Individuals may wish to obtain specific health care services without informing their health care insurers. To that end, the following restriction must be accepted and implemented by the Covered Component:

A request that the Covered Component not send specific information to the Individual’s health care insurer, if the Individual has paid for the service in full without recourse to that insurance.

They need to pay for it up front to ensure that the provider does not lose out on payment for the service. There should be no outstanding balance due (so if the provider wants to apply a "special consideration" that is up to the provider).