May a patient direct a health care provider not to submit a claim to the patient’s health plan for a particular service? Is an in-network doctor required to submit a claim when the patient has directed otherwise? The answers to these questions are usually “yes.”
The HITECH/HIPAA Omnibus Final Rule of 2013 strengthened the right of an individual to restrict a physician’s disclosure of protected health information to a health care plan. This means that, in most cases, patients have the right to pay personally for health care fees and to direct a provider not to submit a claim to the patient’s health plan. If certain conditions are met, the physician must honor the patient’s request. To comply with the rule, physician offices must have in place procedures and documents, as detailed below. *
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