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JLeslie's avatar

Is it insurance fraud to have insurance but choose to self pay for medical services?

Asked by JLeslie (61647points) 1 month ago
13 responses
“Great Question” (0points)

More than once doctors offices and diagnostic centers tell me they can’t charge me self pay once they know I have insurance. I want to write my congressman and the president about this bullshit! Bullshit if it is some sort of law or fraud, or bullshit if it isn’t a law and medical offices use the line. It’s garbage either way.

The latest is the doctor I want to see in a group doesn’t take my insurance, but I already gave my insurance info to the receptionist so now she will only let me see the doctors in the group who take my insurance. I can’t pay to see the other doctor, but if I had no insurance I could.

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Answers

elbanditoroso's avatar

That’s a stupid computer system. You are not required to use insurance if you don’t want to. If you want to pay cash, that’s your choice, not theirs.

Tropical_Willie's avatar

Insurance companies won’t cover all doctors OR hospitals. In my state Blue Cross Blue Shield has a couple of hospitals they will not cover because the hospitals have outrageous rates for standard procedures and operations.

Some of the hospital costs are 50% higher than a neighboring hospital. Maybe the doctor is charging over normal rates.

And some doctors don’t want to have a negotiated rate from the insurance company.

And if it is Medicare, doctors don’t have accept Medicare.

rebbel's avatar

I don’t know whether this is of importance, for the question asked, but what is/could be the reasoning behind being insured but wanting to pay cash nonetheless?

Tropical_Willie's avatar

I don’t either @rebbel $100 instead of a $10 co-pay ?

jca2's avatar

@rebbel: Sounds like the OP wants a specific doctor in the group. Maybe he’s better or has some qualifications she likes.

KNOWITALL's avatar

It may be your state law but it’s not ours. We can opt out and pay cash at any time for doctors or scripts.

If a doctor is out of network, we just pay cash but no one decides who we can see. That’s very odd.

jca2's avatar

@JLeslie: Have you tried asking to speak to the office manager or supervisor? It sounds like a computer thing that maybe the person taking your info doesn’t know how to work around.

chyna's avatar

I find it very odd that the entire group is different. One doctor accepts your insurance and one doesn’t in the same group? Something odd going on there.

JLeslie's avatar

I don’t know if “group” is the correct word, but it is a medical system here, they have 6 offices. Here is the link to their website, but I don’t know if the link will really be helpful, I don’t expect anyone to look at it. Like I said, this is not the first time I have this sort of thing told to me.

This has happened to me in Tennessee and Florida where a person in a medical office says once they know I have insurance they cannot let me pay self pay. I know it has to be bullshit, because people do it. I think it is just idiot office workers who assume something or that’s the company policy, and believe it’s the law. One woman I knew used to work at a diagnostic center and they were instructed not to tell patients the self pay price, because they made so much more money through insurance.

Someone, once told me that insurance companies sometimes put a clause in the agreement they have a with a doctor that the patient cannot be billed less for self pay. I have no idea if that is true.

I don’t pay $10, I pay every single penny, I have a high deductible insurance. I wanted to see a doctor that other people liked. She isn’t taking new patients anyway, but that is not the point, because even if she was I cannot self pay according to the woman who was on the other end of the phone.

snowberry's avatar

No, and I have done it for years.

You may have to switch to another new doctor. Make sure you have all your ducks in a row first before you walk in the door, and don’t give them your insurance. It’s stupid they will not honor your request, but this is typical in my experience.

Cupcake's avatar

This is not my area of expertise, but I am an expert on US healthcare and have navigated difficult health conditions with and without health insurance.

I would guess some practices without enough knowledge do not allow it just to be on the safe side. I don’t see why each practice wouldn’t have their own policy on it… and some allow and others not. It’s probably quite complex, between practice policies, your specific insurance plan, and state/federal rules and laws. Individual providers may have certain preferences and allowances, as well.

I would ask for the practice’s written policy from the practice administrator or billing supervisor, and also call and ask the health insurance. Your state legislators may also be of help.

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