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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

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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 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 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 at 17:59
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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 at 18:50
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    US Healthcare never fails to amaze...
    – SD.
    Feb 16 at 10:43

3 Answers 3

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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.

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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.

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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. Feb 15 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 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.

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