Is it illegal to self pay when I have insurance?

[not2cleverRed]

I suspect what it is, is that they have to document that they filed a claim, on the off chance something is covered, and you pay whatever wasn't covered.

However, I suspect that the gate keeper has been poorly trained, and this is their simplistic understanding of what they are to do.

So no, there is no law against self paying if your insurance won't cover it.

 

[cbg]

Of course, if I'm right about what kind of insurance the OP has, she should just let the clueless office person bill the insurance carrier first since I'm betting there's an out of network benefit in there somewhere. It may take her all year to use it and she'll have to self-pay anyway till she gets there, but in the long run that's going to be a win-win. The worst case scenario is that she never reaches her out of pocket maximum for out of network providers, in which case she self-pays anyway, which is what she's prepared to do all along.

 

[SiliconDawn]

Considering they said, flat out, that if they don't take my insurance they will not accept me as a patient I don't think them filing as out of network is an option. But since it sounds like I won't have the cops beating down my door to arrest me, I will go back and simply tell them I no longer have insurance. I don't have the same insurance as last year so it's not *entirely* a lie, I will just neglect to tell them I have a new carrier. Whoops! My bad. Bad memory and all that.

Sadly the way this clinic is set up the doctors have no control over who is or isn't accepted as a patient so telling the doctor I want to pay cash won't work. They have to direct me to the financial office for arrangements. It's a stupid clinic but the best doctor I've found to help with my medications, so I just really don't want to leave her. I've been trying to find a replacement for 4 months now (since I was dropped from there because I lost medicaid and they didn't take my other insurance) and have yet to find anyone.

 

[PayrollHRGuy]

When you do pay cash you should still file with your carrier yourself. You will either pay down your deductible or get some of the cash back.

 

[SiliconDawn]

I've never done that before. Do I just get a receipt and then call my insurance to file, or do I need something specific from the clinic?

 

[PayrollHRGuy]

Generally the receipt that the clinic gives would have enough information. You may need a claim form from your carrier.

 

[cbg]

Your carrier will be able to tell you what they will accept.

 

[paddywakk]

Sounds to me like they just don't want to see you anymore

What is the name of your state (only U.S. law)? Colorado

I currently have insurance with a very high deductible. I would like to continue seeing a particular doctor (she's the only one who has been able to provide any help) but her office doesn't take my insurance (I used to have Medicaid which they take, but I no longer do). The financial office there said it's illegal to self pay if I have insurance, that they are required by law to bill insurance. Is this true? If I told them I don't have insurance even though I do, will I, or they, actually get in legal trouble if it were discovered?

and this is the excuse.