bjrepar
Contributor
- Messages
- 10
- Location
- Naples, FL
Example: 24 year old on parents insurance, comes into office and wants to pay cash for the visit because they don't want parents to know what is wrong. Is this fraud?
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Insurance vs Cash pay
- Thread starter bjrepar
- Start date
AC32333
Contributor
- Messages
- 10
- Location
- Woodland Hills, CA
See 45 CFR 164.522(a)(1)(vi) below:
(vi) A covered entity must agree to the request of an individual to restrict
disclosure of protected health information about the individual to a health plan if:
(A) The disclosure is for the purpose of carrying out payment or health care
operations and is not otherwise required by law; and
(B) The protected health information pertains solely to a health care item or
service for which the individual, or person other than the health plan on behalf of the individual, has paid the covered entity in full.
(http://www.gpo.gov/fdsys/pkg/CFR-2013-title45-vol1/pdf/CFR-2013-title45-vol1-sec164-522.pdf)
(vi) A covered entity must agree to the request of an individual to restrict
disclosure of protected health information about the individual to a health plan if:
(A) The disclosure is for the purpose of carrying out payment or health care
operations and is not otherwise required by law; and
(B) The protected health information pertains solely to a health care item or
service for which the individual, or person other than the health plan on behalf of the individual, has paid the covered entity in full.
(http://www.gpo.gov/fdsys/pkg/CFR-2013-title45-vol1/pdf/CFR-2013-title45-vol1-sec164-522.pdf)
CatchTheWind
Guest
- Messages
- 648
- Location
- Boca Raton, FL
I concur with the previous two replies. In short, HIPAA not only allows, but REQUIRES you to agree to a patient's request not to send a claim to insurance as long as the patient has paid cash in full for the service.
bjrepar
Contributor
- Messages
- 10
- Location
- Naples, FL
Thank you very much for this information!!! 
MnTwins29
True Blue
- Messages
- 1,194
- Location
- Rensselaer, NY
It's not new - this was part of the HITECH act passed in 2009. The link that is provided above is the "official" link for the that section of the law.
wfriddle
Networker
- Messages
- 43
- Location
- DALLAS CENTRAL
We have a form we make these patients fill out, kind of like an ABN, stating that we are not filing their insurance, nor may they, medical records won't be realeased to insurance unless authorized by the patient and the patient is required to pay in full at time of service. It may not be required but is nice to have to cover our butts.