Wiki Insurance vs Self-Pay

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Blackhorse

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We are pain management specialty office. One PT is covered by Blue Shield and we are in-network with Blue Shield. She has to pay $114 deductible for every office visit. Our cash price is only $90. She choose to pay cash and not use her insurance. Can she do that and is this legal? I have to check what our contract rate is. If it's over $90, can our cash rate below contract rate?
 
According to HIPAA laws, they can pay cash for visits and don't have to have it billed to their insurance. I would be wary of billing below contracted rate. There was a case in my area that a radiology company was charging well below contract rate to cash patients and they were reported to Medicaid by a competitor. The thought is, if they are only charging this patient $90, why are we paying them $114? I am not sure if their rates were lowered, or if they just got a warning and had to raise their rates. So we don't bill below contracted rates, and if our doctors try to bill at a lower level to give the patients a break, I have to warn them to be careful. Just my experience.
 
Check your contract with Blue Shield, and see if it requires you to bill them for services provided to their members.

We don't have a "cash pay rate", we have a "time of service discount", which means if the cash pay patient pays at the time of service, they get the discount. Our policy is, if an insurance company wants to do the same thing, they are welcome to do so (of course, they won't). But our cash pay rate is around the same as our insurance contract rate.
 
thranowski said:
According to HIPAA laws, they can pay cash for visits and don't have to have it billed to their insurance. I would be wary of billing below contracted rate. There was a case in my area that a radiology company was charging well below contract rate to cash patients and they were reported to Medicaid by a competitor. The thought is, if they are only charging this patient $90, why are we paying them $114? I am not sure if their rates were lowered, or if they just got a warning and had to raise their rates. So we don't bill below contracted rates, and if our doctors try to bill at a lower level to give the patients a break, I have to warn them to be careful. Just my experience.
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Thank you. I have talked to our MDs, we'll increase our cash rate as our contracted rate is $114.
 
SharonCollachi said:
Check your contract with Blue Shield, and see if it requires you to bill them for services provided to their members.

We don't have a "cash pay rate", we have a "time of service discount", which means if the cash pay patient pays at the time of service, they get the discount. Our policy is, if an insurance company wants to do the same thing, they are welcome to do so (of course, they won't). But our cash pay rate is around the same as our insurance contract rate.
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Thank you for your input.
 
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