Patients right to restrict billing to insurance
If a patient wants to pay cash for a visit and/or procedure, but he has insurance that we are
contracted with- Can we do this?
or are we obligated to bill the insurance because of our contract? He has a medicaid plan.
Don't know if its a legal law or what?
Any advice is appreciated.
Nancy
The HITECH act included a provision as follows.
(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.
Health plan in this act is defined as:
Health plan means an individual or group plan that provides, or pays the cost of, medical care (as defined in section 2791(a)(2) of the PHS Act, 42 U.S.C. 300gg-91(a)(2)).
(1) Health plan includes the following, singly or in combination:
(i) A group health plan, as defined in this section.
(ii) A health insurance issuer, as defined in this section.
(iii) An HMO, as defined in this section.
(iv) Part A or Part B of the Medicare program under title XVIII of the Act.
(v) The Medicaid program under title XIX of the Act, 42 U.S.C. 1396, et seq....
Based on this, I would say that you must abide by the patient's wish to not have their insurance billed and carefully document this information. You may wish to obtain legal advice regarding how to accommodate this from your organization's health care legal adviser. State medical societies and professional liability companies are also good sources of information on topics such as this.
Hope that helps.
Cindy