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My doctor's cash price is lower than the insurance price. Since I likely won't hit my deductible this year I asked to switch to self-pay.

They told me they are "not allowed" since I have "already presented" them with my insurance card.

Is this legal? They are refusing me treatment unless I pay the higher "insurance" price.

I have United Choice Plus

Ellie Kesselman
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Derek Fulton
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    Unfortunately your only angle would be something like "You did NOT explain this was the procedure at your practice, so I do not accept what you are saying." – Fattie Feb 15 '24 at 14:56
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    Not accepting will not affect what you owe them. Having a clear quote showing that you were promised the other price might, but I doubt you have one. You can't renegotiate price after buying. – keshlam Feb 15 '24 at 16:41
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    @Fattie they'll send you away. They're bound by their contact with the insurer, once you're under that contract nothing you say would change it. – littleadv Feb 15 '24 at 17:59
  • @littleadv sure, but the devil is in the unclear details. Did the OP sort of wave his insurance card, then ask for cash price, or is OP an established already-a-customer customer, etc; in both cases what precisely is the nature of the practice's contract w/ the providers, in what state, etc etc. – Fattie Feb 15 '24 at 18:49
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    @Fattie generally they'd be much more afraid of losing the contract with the insurer than one angry patient. – littleadv Feb 15 '24 at 18:50
  • @littleadv I suppose generally anything. Just TBC, the sense of my comment to the OP was "You're screwed. Your only slim chance is if you take this approach ..." - heh! – Fattie Feb 15 '24 at 18:51
  • "Since I likely won't hit my deductible this year I asked to switch to self-pay." Doctors see plenty of people who think this, then something really bad happens and they end up hitting that deductible max plus whatever they paid before that in cash. They are also likely trying to prevent you from being in that situation, besides what's in the below answers. – computercarguy Feb 15 '24 at 23:35
  • @computercarguy You are right but I've crunched the numbers and I have a rainy day fund in this case. – Derek Fulton Feb 16 '24 at 00:12
  • @DerekFulton, "rainy day" funds have a tendency to evaporate under the harsh glare of a major medical problem. IMO, it's better to use the "rainy day" funds for something fun, rather than an emergency. Even replacing a fridge is more fun than paying for emergency surgery. – computercarguy Feb 16 '24 at 00:52
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    US Healthcare never fails to amaze... – SD. Feb 16 '24 at 10:43
  • Are you referring to the amount that the doctor's office bills the insurance? Or did they already contact your insurance company and tell you what the insurance says you will owe? – rtaft Feb 16 '24 at 13:46
  • @rtaft The amount that I pay the doctor directly, but that would go toward my deductible. – Derek Fulton Feb 16 '24 at 15:00
  • @SD. This isn't a healthcare problem; it's an insurance problem, and far too many of the problems in US healthcare today stem from improperly conflating the two. – Mason Wheeler Feb 17 '24 at 23:05
  • The proper solution to a problem like this is known as "restaurant pricing," because of its two simple rules: 1) the hospital/clinic must have a "menu" listing every product and service it provides, and the price it charges for them, and 2) everyone gets charged the price on the menu, regardless of how they're paying. This does away with sleazy insurance-company shenanigans like this, and also has a long track record of driving prices down significantly. (So of course there's very little enthusiasm in lawmaking circles for enshrining up such an obviously-good policy in law!) – Mason Wheeler Feb 17 '24 at 23:09

3 Answers3

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Is this legal? They are basically refusing me treatment unless I pay the higher "insurance" price.

It is legal, since the "list price" is likely much higher anyway and they're not obligated to provide any discounts. Many doctors offer "cash" discounts or special discounts for uninsured, but they're not required to.

But more importantly, the doctor's office most likely has a contract with that insurance provider (i.e.: they're "in network"), and if so - they're obligated to charge the insured by that provider the negotiated prices set in that contract.

Once you're identified as insured by that provider, you're covered by that contract and the doctor may not even have a say as to how much you're going to pay. They cannot "unsee" your insurance card, so they cannot offer anything to you that is not agreed upon with your insurer.

littleadv
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  • Comments have been moved to chat; please do not continue the discussion here. Before posting a comment below this one, please review the purposes of comments. Comments that do not request clarification or suggest improvements usually belong as an answer, on [meta], or in [chat]. Comments continuing discussion may be removed. – JohnFx Feb 15 '24 at 20:25
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Yes, it's legal. A provider is allowed to decide who they want to offer a discount to, on whatever basis they see fit, as long as they aren't discriminating against a protected class -- and "has insurance" is not a protected class.

Negotiate price before obtaining the product or service. Shop around if you don't like the first quote.

keshlam
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    You may want to reconsider the last line, shop around if you don't like the first quote. In this particular case, finance aside (even though this is money.SE), you may want to stick with the provider based on the quality of the service they provide first, rather than price first. I would personally rather pay a little more (and possibly a lot more) for a good doctor and I feel that I may not be unique in this regard. – Stephan Samuel Feb 15 '24 at 20:53
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    @StephanSamuel: Agreed, but I think that's subsumed under "if". I too would prefer to stay with the providers I know and have an ongoing relationship with -- but I wouldn't be trying to get them to lower their prices. – keshlam Feb 15 '24 at 22:53
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Most people have answered the explicit question about the legality (it is legal). Now, the implicit question remains: what should you do?

Option 1: See another doctor. Don't present that you have insurance and then ask if they have a cash price.

Option 2: Bite the bullet and accumulate the costs towards your deductible. Then make this year the year you do everything. For example, go see your GP for your annual physical. Go get vaccinated for diseases for which your vaccines might be expiring in the next few years (e.g. tetanus). Go fix a nagging injury that you've been putting off. Get some nutritional counseling. Get everything that is covered by your insurance, that will help you. Then a lot of it may be free.

WetlabStudent
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