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Insurance vs Cash pay

  1. #1
    Default Insurance vs Cash pay
    Medical Coding Books
    Example: 24 year old on parents insurance, comes into office and wants to pay cash for the visit because they don't want parents to know what is wrong. Is this fraud?

  2. #2
    See 45 CFR 164.522(a)(1)(vi) below:

    (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.


  3. #3
    Boise, Idaho
    Starting this year there was new information regarding HIPPAA. A patient could request that information for that visit was not sent to insurance.

  4. #4
    I concur with the previous two replies. In short, HIPAA not only allows, but REQUIRES you to agree to a patient's request not to send a claim to insurance as long as the patient has paid cash in full for the service.

  5. #5
    Thank you very much for this information!!!

  6. Default
    where can we find this new law?

  7. #7
    New Windsor, New York
    Quote Originally Posted by lizzetter View Post
    where can we find this new law?
    It's not new - this was part of the HITECH act passed in 2009. The link that is provided above is the "official" link for the that section of the law.


    Director, Health Information Management
    HealthAlliance of the Hudson Valley
    Kingston, NY

  8. #8
    We have a form we make these patients fill out, kind of like an ABN, stating that we are not filing their insurance, nor may they, medical records won't be realeased to insurance unless authorized by the patient and the patient is required to pay in full at time of service. It may not be required but is nice to have to cover our butts.

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