Selfpay discounts only to uninsured not allowed for insured?

[Akulo]

I do billing in New York.

I'd like clarification if it's legal to discount self paying uninsured patients for prompt payment upfront.

I seems like it's legal for insured patients from what most people are saying here, (some say it's not) but what about patient's with high deductibles with insurances we are contracted with? Can it be done if we're not contracted?

Can a patient chose not to use insurance to pay the lower prompt paying discount rate?

 

[SaundraMoy]

CMS Guidelines

Good Afternoon,

It is my understanding that as long as there is a policy in place that treats all self-pay patients the same and equally you should be okay. If the patient is insured by an insurance that you contract with it might get a bit stickier.

This is an article from the CMS on the subject.

https://www.cms.gov/Medicare/Medica...AcuteInpatientPPS/downloads/FAQ_Uninsured.pdf


I hope these are helpful.

Saundra

 

[Cheezum51]

I've always heard that it isn't advisable to give a patient, who is covered by an insurance you're contracted with, a discount on their payments copays or deductibles. It can set you up for a situation where the insurer can force you to do it for all of the subscribers you see under their plan because you've set a precedent.

As someone mentioned previously, if the patient is uninsured and you want to give them a self pay discount, it should be uniform for all patients in that category.

Tom Cheezum, O.D., CPC