Under HIPAA, patients do have a right to request that an insurance claim not be filed. You also have a right to require payment at the time of service in such a case.
See https://www.hhs.gov/hipaa/for-professionals/faq/3026/under-hipaa-may-an-individual-request-that-a-covered-entity-restrict-how-it-uses-or-discloses-that-individuals-protect-health-information/index.html\
Since Medicare participation and most insurance contracts require that a claim otherwise be filed for covered services, you would want to get that request in writing from the patient. I would also ask the patient to agree in writing not to request that a claim be filed at a later date. I have heard of patients coming back later with a request to file, which then results in a denial due to no authorization, timely filing, or other circumstances, resulting in no patient liability and leaving the provider holding the bag.
You would have to read your actual contracts, but I think insurance contracts generally frame the filing requirement in the context of covered services, so it may not be required to file a claim for services that are never covered (cosmetic procedures, for example). I'm not sure about any Medicare filing requirements with respect to services that are never covered.
Either way, if you get the patient request in writing you should be clear not to file.
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David Smith FACMPE
Executive Director
United Imaging Consultants
Mission KS
(785) 393-8387
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Original Message:
Sent: 06-06-2023 13:11
From: Dennis Chaltraw
Subject: Opting out of using Commercial insurance in lieu of Self Pay Options
Is there a consensus in how practices should handle self-pay requests from patients when they ask to opt out of using their commercial insurance? This question is focused on services that are NOT covered by their insurance, such as PRP injections, or venous surgeries. We're getting various opinions from compliance and legal perspectives that insurance must be billed in all cases...which of course, returns denials that, for the most part, reflect zero patient responsibility.
This question is NOT related to high deductible plans or standard medically necessary covered services, a question we get occasionally from patients. Any commentary on essentially a patient's right to request we NOT bill their insurance, (in this case for services that will NOT be covered by their insurance), is appreciated, thanks!
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Dennis J Chaltraw, CRCE
Director Revenue Cycle Management
Oregon Imaging Centers / Radiology Associates / ReNew Vascular Institute
dchaltraw@oregonimaging.com
Eugene OR
541-302-7771
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