Wiki SELF-PAY versus INSURANCE

Create Wiki
H

heart123

Guest
Messages
315
Location
Greenwood, SC
Best answers
0
so if a pt. has insurance but there deductible is high and they want to be self-pay what are your thoughts and legally what stands anyone know????
i get alot of different ideas from people i work with on this
some say we have contracts with the insurance companys and we need to abid by them and some say its ok to take self-pay even though they have insurance
What are your THOUGHTS please
 
My first thought is if the patient has a high deductible, wouldn't they want to have the fees applied to their deductible? If they have to pay either way it would be good to have the monies applied to the deductible in case they need to access additional benefits that year. The only reason I can think of that they would prefer personal pay is if your office has two fee schedules...one for insurance and one for personal pay?

In general the comments you received are correct that you would first need to look at your contract with the carrier to ensure that there are no requirements with this matter, in most cases there will not be. If not, then it would be up to patient whether or not they would want to access their medical insurance benefits.
 
I believe patient's have a legal right to request that providers not submit a claim to their insurance provider if they so choose. I don't believe the payer can put anything in a contract with the provider to require that a claim be submitted if the patient does not wish it. So I don't believe there is any compliance issue with allowing a patient to opt to be self pay. It could be an issue if the patient decides later to submit their own claim to the insurance for your provider's services and if the amount that your payer's contract says you can accept differs from the amount that the patient actually paid. But other than in that situation, I don't believe it is problematic.
 
We just have a form that states they do not want to file the claim to insurance and would like to be billed as a self-pay. This should resolve the issue if/when the patient returns and states that he/she want to now have it billed with her insurance or a claim form so she can file it, etc. We have found that sometimes they want the discount but then return and want it filed.
 
You must log in or register to reply here.
Top