In response to yesterday’s Balance Billing email, I received questions as to whether (1) a provider may charge its uninsured patients lower rates than it charges insured patients for the same services, or (3) whether a provider may charge lower rates to patients who pay cash. 

The answers are Yes (conditionally – see below) and No, respectively. 

The answer to the first question, whether a non-insured patients may be charged less for the same treatment then an insured patient, depends.  If the non-insured patient absolutely does not have any insurance at all, is not covered by any sort of plan and there will be no submission on behalf of treatment for the patient to any insurance company by the practice or the patient then the rates charged to the patient will not be considered when the provider’s usual and customary rate is determined, and therefore, there is no insurance fraud if the patient is charged a lower rate.  Be advised that if the provider participates with any third party payor, the provider may have a contractual relationship with an insurer that may limit the Practice’s discretion to charge lower fees to different categories of patients.  

The answer to the second question, whether a provider may charge patients who pay cash lower rates, is no.  Because, offering a cash discount invariably alters that providers usual and customary rate tabulated by third party payors, and therefore, constitutes insurance fraud.  

The safe route – charge the same per treatment/procedure for all patients.

For additional information on this topic, contact Jennifer Kirschenbaum at (516)-747-6700 ext. 302 or at


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