uhhhh

PLAIDMAN

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Could someone help me out with this one.....I recently had a "discussion" with a billing/insurance specialist and this person thinks it is a law that patients HAVE to use their health insurance.

I told this person that was ridiculous. I realize there are some regulations to keep in mind if you are accepting cash instead of submitting to ins.

Has anyone come across this before........can you lead me to any documentation??
 

PLAIDMAN

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Update

Could someone help me out with this one.....I recently had a "discussion" with a billing/insurance specialist and this person thinks it is a law that patients HAVE to use their health insurance.

I told this person that was ridiculous. I realize there are some regulations to keep in mind if you are accepting cash instead of submitting to ins.

Has anyone come across this before........can you lead me to any documentation??
We spoke to our health care attorney and were told there is no law stating you have to use your health ins. BUT it is written into our contract with our network, and is included in the payor/patient contract. I did not get a why it is written that way.

I can't imagine a payor saying we require you to make us pay for it.
 

melzinser

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What insurance do they have?

Then check your contract if you have one with that carrier. There very well may be a clause that requires you to file a claim for all services rendered to a covered individual and, I think most importantly, only charge contracted fees for covered services.

My understanding is if you are not contracted with their carrier, or there is no such clause in your contract, the patient is free to seek whatever care they want and pay out-of-pocket for it.
 
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