Can Patients with Insurance Choose to Self-Pay?
Yes, patients even with insurance have the right to opt into paying for medical services on a cash pay basis
You can still submit a claim to your insurance for partial or full reimbursement according to plan documents.
Why would someone choose to be cash pay?
Providers (doctors, hospitals, and pharmacies) often offer lower self-pay rates because:
They avoid administrative costs associated with insurance billing
There’s no need for claims processing
Payment is made upfront, with little to no delay
Because cash pay simplifies the process and reduces overhead, providers may pass those savings on through discounted rates which can sometimes be lower than insurance-negotiated prices.
Patients who choose to self-pay have important protections:
Privacy Rights: Under federal law (HITECH Act, 45 CFR § 164.522), you can request that your provider not share your information with your insurance plan, as long as you pay in full out-of-pocket. *The provider does have the right to deny non-emergent care on a cash pay basis.
Good Faith Estimates (GFE): You have the right to request a Good Faith Estimate of expected charges before receiving care, helping you understand and plan for costs in advance. See This guide here on Understanding your Right to a Good Faith Estimate (GFE).
Choosing to self-pay gives you more control over how you pay for care and may offer cost savings in certain situations. Be sure to ask your provider about pricing options and request a Good Faith Estimate before moving forward. Reach out to your plans care navigators for any assistance!