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Pkirsch1

Networker
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Bristol, CT
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Is it OK if the provider does not want to use the patient's insurance, and asks them to self-pay?
We are in CT.

Thank you
 
Pkirsch1 said:
Is it OK if the provider does not want to use the patient's insurance, and asks them to self-pay?
We are in CT.

Thank you
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It really depends on what insurance the patient has and also whether or not the provider has a contract with that insurance. For example, if the patient has Medicare, the provider can only do this if they have opted out of Medicare and make a contractual agreement with the patient. On the other hand, if it’s a commercial insurance plan and the provider is not contracted with that company, then it usually fine to ask the patient to self pay.
 
Is your provider contracted or not? If yes, then, they cannot do this. If no, then, I believe that it would be OK as long as you get something in writing from the patient in advance.

But I’d caution that you are asking a compliance question here that could have legal ramifications for your provider. This really should go to your compliance officer. Not a good idea to take legal advice from posts on an Internet forum.
 
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