I’ve been incredibly negligent in posting here the past several months, hopefully getting down to one job will allow me to post here more frequently (and yes, I’ve said things like that before).
Today I wanted to address something I’ve gotten several e-mails on over the past few weeks. Early last year I put up a post titled “Insured patients can save money by pretending to be uninsured.” The gist of the article was that the negotiated rates paid by insurers to doctors are sometimes more than the cash price the same doctor might charge someone who is uninsured. In those circumstances, for people who are going to be paying the full bill because it’s under their deductible, it’s better to hide the fact that you have insurance and just pay the cash price.
The question I’ve gotten a couple of times recently has to do with the legality of doing this, and what might happen if the doctor finds out you are insured. The answer to the first one is easy – it’s completely legal to not use the insurance you have, or at least I’ve never heard of an insurance policy requiring that their policyholders use them for all treatment.
The second one can be a little tricky. A couple of people have told me that they’ve tried to get the cash price after they have given their insurance information, only to be told they have to charge them the negotiated rate. Unfortunately, this is true, even though the patient will be paying the full price, whatever that may be. Once you tell a doctor’s office you are insured, they are contractually obligated to charge you the rate they agreed to with the insurer.
Someone else described the following scenario: they’ve been getting the cash price by not telling the doctor they are insured, what happens if they find out they’re insured? Will the doctor go back and have to re-price all the past bills? Two thoughts.
One, it depends on what exactly the doctor finds out the patient is insured. If they only find out that now, as of this particular visit the patient is insured, they’re likely going to assume it’s new coverage and not ask about whether past visits could have been covered under the insurance policy as well, so this shouldn’t be a problem.
If, on the other hand, the doctor discovers the policy was in effect during previous treatments, there might be a problem, and I just don’t know what might happen. Some doctors might opt for a “water under the bridge” attitude and not worry about it (there’s not much financial incentive for them to pursue the higher charge, as the marginal increase in revenue is likely to be gobbled up with the bureaucratic hassle of going back and dealing with it), while others may insist on going back. It probably depends on the doctor and how devoted they are to the third-party payment system (if they were offering good cash prices to begin with, the answer is probably “not very”).
I’d be interested in hearing any experiences anybody has had that relate, shoot me your thoughts at selfpaypatient [at] gmail [dot] com.