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They also charge me more at the doctor when I have insurance... is it ok to say that you don't have insurance and make a claim later?

_-david-_ 6y ago
It might be considered fraud but it would probably depend on your state / country.
labster 6y ago
Many doctors discount their care when providing it to people who don't have insurance to help them afford medical care. It's probably legal to make a claim later, but you're effectively lying to the doctor so you can receive a charitable contribution. It's ok to do it if you don't mind feeling like a welfare fraudster.
- toast0 6y ago
  They may also discount their care if they get paid upfront and don't have to submit the claim and wait for reimbursement. But it might also violate their network agreement with the insurer to not do the submital?
- thebooktocome 6y ago
  It's not a charitable contribution; the doctor in this situation is unethically applying differential pricing.
  - deleted 6y ago
    [deleted]
  - kinkrtyavimoodh 6y ago
    So it's unethical to charge less to a person who might not be able to afford the higher price? I think we have different definitions of the word ethical.
    - colejohnson66 6y ago
      It’s viewed as unethical to some because when you flip the script, it’s: “charge rich people more simply cause they’re rich”. Which isn’t a good argument, but it’s what I’ve heard.
      - kinkrtyavimoodh 6y ago
        But rich people are not charged because they are rich. They are charged because they have insurance. And it is insurance that has led to this bizarre situation where the free market is completely broken and you can't confidently put a price number to a medical product or service. If almost everyone was paying for their medical care out of their own pocket we would not be in this situation. And there are plenty of other countries where this is the case. In India for example, individual doctors literally have a board with a list of what they charge for various services, and if you visit a hospital, someone at the reception would be happy to help you with these. You want a general ward? Here's the price. You want a private air-conditioned room with five-star catered meals, here is the price.
- franciscop 6y ago
  You are paying more for your insurance because the doctors offer different prices to different people (since insurance prices follow cost). This likely locks some people out of insurance altogether.
crazygringo 6y ago
It's totally legal to pay the cash price if it's lower. It's not against the law to have insurance and not use it. But if you try to make a claim later, I've never heard of that working. They'd either require that you pay the difference towards the price with insurance first, reject it entirely for not following in-network procedures (most likely), or else reimburse you according to out-of-network rates, which will be far lower. I can't imagine any scenario where you'd save money in the end. If you haven't reached your deductible and don't think you'll reach it, then it can make sense to pay in cash and just not report it to your insurance company at all. That's fine (though it doesn't count toward your deductible of course). But also note it's not a universal that insurance prices are higher than cash. At every doctor and dentist I've ever seen in New York City, insurance prices have always been lower than not having insurance. I ask every time, since I have a HDHP. One of the benefits of health insurance is often precisely that they negotiate lower rates with doctors, because (in theory) they bring in more patients to make up for it. Of course, if you're paying cash the doctor can give you a discount if they choose to, if you tell a sob story... which I've never heard of happening with insurance.
- FireBeyond 6y ago
  > But if you try to make a claim later, I've never heard of that working. They'd either require that you pay the difference towards the price with insurance first, reject it entirely for not following in-network procedures, or else reimburse you according to out-of-network rates, which will be far lower. I can't imagine any scenario where you'd save money in the end. Unless you're the provider, in which case there are many cases of providers billing insurance after taking a cash patient. Effectively "reverse balance billing", aka fraud. If you see instances where providers "accidentally" process your care through your insurer after paying cash, tell your insurer. While it may seem like a non-issue, and that the provider will claim accident, I assure you that for all their (many, many) faults, insurance companies dislike provider fraud too, and similar to credit card chargebacks, too many "accidental" billings will become problematic to the provider.
deleted 6y ago
[deleted]

_-david-_ 6y ago

It might be considered fraud but it would probably depend on your state / country.

labster 6y ago

Many doctors discount their care when providing it to people who don't have insurance to help them afford medical care. It's probably legal to make a claim later, but you're effectively lying to the doctor so you can receive a charitable contribution. It's ok to do it if you don't mind feeling like a welfare fraudster.

toast0 6y ago
They may also discount their care if they get paid upfront and don't have to submit the claim and wait for reimbursement. But it might also violate their network agreement with the insurer to not do the submital?
thebooktocome 6y ago
It's not a charitable contribution; the doctor in this situation is unethically applying differential pricing.
- deleted 6y ago
  [deleted]
- kinkrtyavimoodh 6y ago
  So it's unethical to charge less to a person who might not be able to afford the higher price? I think we have different definitions of the word ethical.
  - colejohnson66 6y ago
    It’s viewed as unethical to some because when you flip the script, it’s: “charge rich people more simply cause they’re rich”. Which isn’t a good argument, but it’s what I’ve heard.
    - kinkrtyavimoodh 6y ago
      But rich people are not charged because they are rich. They are charged because they have insurance. And it is insurance that has led to this bizarre situation where the free market is completely broken and you can't confidently put a price number to a medical product or service. If almost everyone was paying for their medical care out of their own pocket we would not be in this situation. And there are plenty of other countries where this is the case. In India for example, individual doctors literally have a board with a list of what they charge for various services, and if you visit a hospital, someone at the reception would be happy to help you with these. You want a general ward? Here's the price. You want a private air-conditioned room with five-star catered meals, here is the price.
franciscop 6y ago
You are paying more for your insurance because the doctors offer different prices to different people (since insurance prices follow cost). This likely locks some people out of insurance altogether.

crazygringo 6y ago

It's totally legal to pay the cash price if it's lower. It's not against the law to have insurance and not use it. But if you try to make a claim later, I've never heard of that working. They'd either require that you pay the difference towards the price with insurance first, reject it entirely for not following in-network procedures (most likely), or else reimburse you according to out-of-network rates, which will be far lower. I can't imagine any scenario where you'd save money in the end. If you haven't reached your deductible and don't think you'll reach it, then it can make sense to pay in cash and just not report it to your insurance company at all. That's fine (though it doesn't count toward your deductible of course). But also note it's not a universal that insurance prices are higher than cash. At every doctor and dentist I've ever seen in New York City, insurance prices have always been lower than not having insurance. I ask every time, since I have a HDHP. One of the benefits of health insurance is often precisely that they negotiate lower rates with doctors, because (in theory) they bring in more patients to make up for it. Of course, if you're paying cash the doctor can give you a discount if they choose to, if you tell a sob story... which I've never heard of happening with insurance.

FireBeyond 6y ago
> But if you try to make a claim later, I've never heard of that working. They'd either require that you pay the difference towards the price with insurance first, reject it entirely for not following in-network procedures, or else reimburse you according to out-of-network rates, which will be far lower. I can't imagine any scenario where you'd save money in the end. Unless you're the provider, in which case there are many cases of providers billing insurance after taking a cash patient. Effectively "reverse balance billing", aka fraud. If you see instances where providers "accidentally" process your care through your insurer after paying cash, tell your insurer. While it may seem like a non-issue, and that the provider will claim accident, I assure you that for all their (many, many) faults, insurance companies dislike provider fraud too, and similar to credit card chargebacks, too many "accidental" billings will become problematic to the provider.

deleted 6y ago

[deleted]