Wiki SELF_PAY versus INSURANCE

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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.
 
If a patient is under another person's insurance (like their parents), they might not want to have them find out (like screenings for HIV, drug, psych, etc.). Also, some clinics offer a small (~10%) discount for Self Pay patients and if the patient has a very high deductible with very low health maintenance needs (only need a couple visits a year), and would never hit their deductible; they might want to go Self-Pay with the lower rate, instead of paying full cost towards their deductible.

However, in general I agree with Chelle; that using your deductible is almost always a smart idea. Especially when you really need a doc (Urgent Care, ER, etc.).
 
Omnibus Rule

In addition to what Pathos stated, the HIPAA Omnibus Rule does allow a patient to not allow any of their PHI for a service that they decided to pay out of pocket to be disclosed to their insurer. The patient may opt out of that for some of the reasons Pathos stated, they may fear that if the plan knows about their condition their premiums will rise or that the payer will share that information with others that may harm the patient. In the end, it doesn't matter what the reason is, sound or not, but this is another situation where the patient may want to pay themselves instead of through their insurance carrier.
 
Self pay vs Insurance

Hi

I agree with Lance...patients have the right to decide to pay own bill instead of thru insurance. Every time you go to the hospital or doc office for treatment this is all tracked thru your life time as a patient with illnesses suffer...medical history. It is the patient's right to provide a bit more privacy on what covering by paying self pay. If he gets a discount for paying self pay I would question that because it would be in conflict with insurance network and contract. However if for a HIV or STD problem ...yeah let them pay if want too.


I hope this helps


Lady T.
 
Just to clarify the above, this is not a matter that you can make your own decision about, nor does it have anything to do with what's in your contract. It is FEDERAL LAW that if the patient requests for a claim not to go to insurance, you are REQUIRED to comply with their request (as long as they have paid for the service in full).
 
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