We are a private infertility practice in Utah. Are we obligated to bill insurance if a patient has coverage?

UPDATED: Oct 1, 2022

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We are a private infertility practice in Utah. Are we obligated to bill insurance if a patient has coverage?

Sometimes the infertility testing and treatments carry such a low reimbursement
rate. We’d like to stop billing out semen analysis and charge patients our self
pay rate. We’re not obligated to bill insurance for an elective service, are we?

Asked on January 29, 2019 under Insurance Law, Utah


SJZ, Member, New York Bar / FreeAdvice Contributing Attorney

Answered 4 years ago | Contributor

You don't have to bill their insurance IF you provide prior notice (e.g on your website, on the phone when a prospective patient calls, in person, etc.) that you do not take insurance for certain procedures. The patient has to know in advance if you will or will not accept insurance for their procedure, so they can decide whether to get the service through you or not. That's the law; however, you also need to check any agreements or contracts you have with insurers, to see if you have agreed contractually to process all claims, etc. for their insured; if you did not agree in a contract to bill the insurer for any service their insureds receive, you would have to do what you agreed to do.

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