Wiki accept assign or not accept assign

[bill2doc]

My doc's are non-contracted trauma surgeons who are only contracted with Medicare. On the accept assign portion of the claim am I choosing NO for all other than Medicare. Is what I'm saying when I say NO that I want to be paid and full and can I balance bill the patient the difference ??? Also, by saying NO is my payment going to the patient. Any non-par billing out there to help please.

Thanks so much

 

[ajs]

My doc's are non-contracted trauma surgeons who are only contracted with Medicare. On the accept assign portion of the claim am I choosing NO for all other than Medicare. Is what I'm saying when I say NO that I want to be paid and full and can I balance bill the patient the difference ??? Also, by saying NO is my payment going to the patient. Any non-par billing out there to help please.

Thanks so much

What you are saying is that your provider IS NOT contracted, so the payment will reflect however that plan pays for non-contracted services and you will be able to bill the patient for any portion not reimbursed by the insurance plan. The insurance plan may elect to send the payment to the patient since you are not contracted.

 

[baskiles]

Just needing some clarification---If we choose accept assignment (YES) in box 27 of a 1500 claim form for an insurance company (other than Medicare) that we are not contracted with, are we saying that we will only charge the patient that insurance carrier's allowed amount even though we are not contracted with that insurance carrier AND we cannot balance bill the patient for the complete and total amount of our charges? On the flip side- if we choose (NO) in accept assignment for an insurance company that we are NOT contracted with, we can bill the patient for the total amount of charges? Looking forward to your response.

 

[SharonCollachi]

That depends on your state, and if the services are inpatient. In California, we have a "no surprise bills" law, where if the hospital is contracted, then the other providers that see the patient in that hospital are treated as in-network as well.