US · guidance
CMS Pub. 100-02, ch. 16, § 40.2
Provider, Physician, or Supplier Bills Only Insured Patients
A3-3152.B, HO-260.2.B
Some providers, physicians, and suppliers waive their charges for individuals of limited
means, but they also expect to be paid where the patient has insurance which covers the
items or services they furnish. In such a situation, because it is clear that a patient would
be charged if insured, a legal obligation to pay exists and benefits are payable for services
rendered to patients with medical insurance if the provider, physician, or supplier
customarily bills all insured patients - not just Medicare patients - even though non-insured patients are not charged.
Individuals with conditions which are the subject of a research project may receive
treatment financed by a private research foundation. The foundation may establish its
own clinic to study certain diseases or it may make grants to various other organizations.
In most cases, the patient is not expected to pay for treatment out-of-pocket, but if the
patient has insurance, the parties expect that the insurer will pay for the services. In this
situation, a legal obligation is considered to exist in the case of a Medicare patient even
though other patients may not have insurance and are not charged.
History
(Rev. 1, 10-01-03)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
d6b207c98ba8174e7654b9efe0907fb87d8004d91b10e9b325c3621aa92a2589
The link goes to the issuing authority’s own document — the one we read to produce this record. Where a source publishes whole titles rather than sections, your browser may need a moment to jump to the provision.
Unofficial copy of government-published law, reproduced from official sources with full provenance. Not an official publication; verify against official sources before relying on it in a filing. Records in the 'guidance' corpus, and only that corpus, are sub-regulatory (interpretive guidelines, survey procedures) and are not binding law. Validity bounds follow each jurisdiction's declared temporalBasis.