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Thread: Legality in filing insurance

  1. #1

    Default Legality in filing insurance

    AAPC: Back to School
    If a patient comes in with insurance that we are contracted with but wants to opt out of using that insurance and be a self pay patient, are we contractually bound to file the insurance anyway?
    A patient is seen for varicose veins and the doctor suggests a procedure that could be considered cosmetic. The patient doesn't want to wait for pre-determination before having the surgery. She is ok with paying the service in full. We have her sign a waiver saying that she has chosen not to wait for pre-determination. Do we still have to file the insurance?

  2. #2
    Join Date
    Apr 2007
    Athens, Ga.


    I do not believe that a patient is required to use their insurance just because they have it. If they want to pay the premiums but not get any benefit, that's their choice! I suppose I could be wrong, or it could depend on the contracts.
    Walker Bachman, CPC, CPPM

  3. #3
    Join Date
    Apr 2007
    South Salt Lake City


    I agree with Walker22 as far as I am aware that is up to the patient. Some people have plans with very high deductibles and when they haven't used it all year and come in November they would rather just pay for the visit since they will have to anyways. The only thing that I have run into is with Medicare patients they have to sign a ABN form that they agree to pay for the visit because it wont be covered by medicare for whatever reason. Good luck.
    Jody Thompson, CPC

  4. #4
    Join Date
    Apr 2007
    Madison Area Chapter in Madison WI


    Just to make sure you are on firm ground, I recommend that you contact the insurance carrier with that question. Thanks.
    Happy Coding, Claudia

    Claudia Yoakum-Watson, CPC
    Coding, Compliance, & Reimbursement Solutions
    ccrsconsulting.com - website

  5. #5


    In all my years of billing it has been my experience that we are never "legally" bound to bill insurance. Insurance billing is a courtesy to the patient. I worked for Planned Parenthood for a couple years and many times we would have patients who had insurance but opted to not use it because they didnt want their parents or others to know they were seen with us so they would not use it. We would just charge them as self pay patients.

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