Is it illegal to pay for a doctors visit with cash even though you have insurance?

Question

We are in CA and my mom needs to take my son to the doctor. I'm out of the area and can't get the ID card to her. She called her doctor and wanted to pay cash but they told her it's illegal to pay cash if you have insurance? I don't think that's right.

Answer 1

It's not true.  It's not illegal to pay with cash, if she has insurance.

Answer 2

Just give the doctor the insurance info over the phone. They will be able to verify it that way. Fax a card copy to the doctor's office.

If you want to pay cash for simplification, ask the doctor for a "Superbill" which will have all the info the insurance needs to pay the claim and she can submit the bill herself. The doctor will receive the EOB with the payment, make the necessary contractual adjustments and send the refund back to her.

Answer 3

No it's not illegal.  Just the dr's generally charge more when someone uses insurance.  BUT what you should do is call your insurance company.  He should be covered no matter where he is.  The insurance company will tell you what you should do.

Answer 4

Huh???  No way!!!

If you pay cash, you simply send a copy of the bill to the ins co  to ask for reimbursement.

You run the risk of paying more than the ins co will pay, or reimburse you, . Why not fax rthe dr a copy of your insurance card???  The Dr might accept what your ins would pay , as payment in fuill thereby saving you  some $$$.

Answer 5

It is not illegal to pay cash up front for service when you have health insurance.  There are a few questions that you must consider before paying up front for the services. The main problem that insurers run into when paying up front for services is the possibility that they may be overpaying.  If this doctor is a in network doctor with your insurance company then it is likely that there will be discounts taken on the bill. The discount amount is the write off amount.  For example, if an office visit is $100 and the approved amount is only $80.00 then the provider would write off the $20.  If you had paid $100 up front then you would have potentially paid the $20 discount that you are not liable for.  I would contact your insurance company to find out if the doctor that your son is seeing is in network.  If you do not have a card you can give the providers office the phone number to your insurance company and they can call and verify benefits.  This is always good to do anyways so you have an idea of how much out of pocket you will be paying.  Most insurance companies have a website for members that show proof of coverage and you may be able to print out a copy of the ID card from their website.  If you do end up paying up front for the services make sure you get an “itemized” claim that you can submit to your insurance company for reimbursement. You will want to make sure the claim has a diagnosis code on it, CPT code, date of service, patient information such as date of birth, member number. Lastly make sure the claim shows a zero balance so the insurance company knows to reimburse you and not the provider. I would even write directly on the claim “PAID” so no errors are made. Hope this helps.