Wiki accept assignment

[JRaines64]

I work at health center on a college campus, so we do not contract with any insurance companies. But we do say we do accept assignments. Since we do that, are we supposed to write off any difference between what we bill and they allow, or can we balance bill them the difference between what we charged and what they paid?

Thanks,
Judy

 

[cgaston]

If you tell someone that you accept assignment it means that you will accept the insurance company ALLOWED amount as payment in full. So if the insurance company does not reimburse you their entire ALLOWED amount you can bill the patient for the difference between the allowed amount and the payment.


For example: your charge is $300, the insurance company allows $200 and pays you $150. If you accept assignment you can bill the patient the $50 difference between the $200 ALLOWED amount and the $150 payment.

A non-par provider doesn't have a contract so they can bill the patient the difference between the billed amount and the payment received ($300-$200 = $100) since there is no contract stating they will accept a reduced rate.


You do not have a contract with any insurance company so you can technically balance bill for everything not paid by the insurance company. However, if you tell patients that you accept assignment then I think it is bad form to surprise them with a balance bill.

NY enacted a Surprise Bill Law back in 2015 to protect patients from these "surprises" after receiving care from a non-participating provider.

 

[thomas7331]

If you tell someone that you accept assignment it means that you will accept the insurance company ALLOWED amount as payment in full. So if the insurance company does not reimburse you their entire ALLOWED amount you can bill the patient for the difference between the allowed amount and the payment.


For example: your charge is $300, the insurance company allows $200 and pays you $150. If you accept assignment you can bill the patient the $50 difference between the $200 ALLOWED amount and the $150 payment.

A non-par provider doesn't have a contract so they can bill the patient the difference between the billed amount and the payment received ($300-$200 = $100) since there is no contract stating they will accept a reduced rate.


You do not have a contract with any insurance company so you can technically balance bill for everything not paid by the insurance company. However, if you tell patients that you accept assignment then I think it is bad form to surprise them with a balance bill.

NY enacted a Surprise Bill Law back in 2015 to protect patients from these "surprises" after receiving care from a non-participating provider.

I disagree with this - 'accept assignment' does not mean that you are accepting a particular amount as payment in full, it only means that the patient has 'assigned' their benefits to the provider, and that the provider will 'accept' these benefits directly from the payers, in the form of payments, toward fulfillment of the patient's bill. In the absence of a contract, or of a regulatory requirement such as the one mentioned above or the 'deemed acceptance' rules for Medicare advantage plans, a provider is not required to accept that payment or the payer's allowed amount as payment in full, and the patient may be balance billed.

All that said though, I do agree that this terminology is confusing to patients, and the best practice is to make sure they clearly understand the terms of their responsibilities in advance of providing services.