Insurance is often a massive headache for many offices. However, it does not have to be. Don’t get me wrong, it will always be an annoyance, but insurance handled well should not stress you out.

If you are a network provider, you know that your provider agreements require you to file claims with the insurance carrier. I am not suggesting you breach these contracts; however, the patient is the higher authority. It is our obligation to let patients know what their payment options are.

Thanks to HIPAA/HITECH regulations you now can allow a patient opt out of filing their health insurance where the situation warrants.

If a patient elects to opt out of their insurance, you should have them sign an “Election to Self-pay” form. By signing the “Election to Self-Pay” the patient is stating that they have chosen to opt-out of their insurance and by doing so, you will not be filing a claim with their insurance company.

The most common reasons for an opt out is to avoid the insurance company dictating the treatment. Any procedure that a patient wants which is not feasible to do under massively reduced fees (veneers, cosmetics, nitrous, sedation, hybrid pros, etc.) the patient can opt to not involve insurance at all for that procedure. This allows you to find a mutually beneficial relationship with the patient and completely prevent insurance from ever getting involved in the future.

These laws governing HIPAA and the ability to opt out are federal in nature, so the only thing to be concerned about is federal plans (Medicaid, TriCare, GEHA), in which if you are in-network you either follow the fees or you refer the case out. All other PPO plans you can use this form.

The conversation with the patient should go something like this:

Team Member: “Mrs. Jones, we verified your insurance benefits and they will not pay for X treatment at all (or insurance will not allow us to provide you the level of quality you want).

Most patients tell us they don’t want to sacrifice quality just to satisfy the insurance company’s requirements.  You have the option to not involve your insurance carrier for this procedure and pay us directly, or we can refer you to someone out of network who can do this work for you. What would you prefer to do?”


Team Member: “Mrs. Jones, many of our patients who see the benefit in a medical procedure yet whose insurance plan has restrictions like yours choose to not involve the insurance company and choose instead to sign up for a membership plan instead.” This is common and perfectly legal.  Would you like more information on this? 


Patient: Sure, how do we do that?

Team Member: If you choose to opt out of us involving insurance, there is a simple HIPAA form to sign that outlines this process. This will allow us to provide the quality care you want and deserve.

You can find a sample copy of this form under the free forms download page here, in the Insurance Documents section: