What Is Meant by the Phrase Accept Assignment?

“Accept assignment” is a common phrase in healthcare billing that describes an agreement between a healthcare provider and an insurance company. When a provider accepts assignment, they agree to accept the insurance plan’s approved amount as full payment for covered services. This means the provider will not bill the patient for any difference between their standard charge and the insurer’s approved amount, beyond applicable patient cost-sharing like deductibles, co-payments, or coinsurance.

Implications for Patient Costs

When a healthcare provider accepts assignment, it directly impacts a patient’s financial responsibility. The provider agrees to bill the insurance company directly and accept the insurer’s allowed amount for the service. This allowed amount is the maximum the insurer will pay for a covered service. The patient is then responsible only for their share of the cost, such as deductibles, co-payments, or coinsurance.

A significant benefit of a provider accepting assignment is protection against balance billing. Balance billing occurs when a provider bills the patient for the difference between their charged amount and the amount the insurance company pays or approves. Providers who accept assignment cannot balance bill patients for this difference. This helps patients avoid unexpected medical bills, especially for out-of-network services where balance billing is more common.

Conversely, if a provider does not accept assignment, the patient may face higher out-of-pocket costs. The provider can bill the patient for the full amount of the service, and the patient might then need to seek reimbursement from their insurance company. The patient could also be balance billed for the difference between the provider’s charge and the insurance company’s allowed amount.

Medicare and Assignment

Within the Medicare program, “accept assignment” affects beneficiaries’ costs. When a Medicare provider accepts assignment, they agree to accept the Medicare-approved amount as full payment for covered services. This amount is the fee Medicare determines is appropriate. The provider bills Medicare directly, and Medicare typically pays 80% of this amount after the beneficiary has met their annual deductible.

The patient is then responsible for the remaining 20% coinsurance of the Medicare-approved amount. Providers who are “participating providers” with Medicare always accept assignment for all Medicare claims. This protects beneficiaries from excess charges.

However, “non-participating providers” may or may not accept assignment. If a non-participating provider does not accept assignment for a service, they can charge the patient up to 15% more than the Medicare-approved amount; this is known as the “limiting charge.” The patient is responsible for this additional 15% charge, plus their standard 20% coinsurance and any unmet deductible. The patient might also be required to pay the full amount upfront and then submit a claim to Medicare for reimbursement.

Finding Providers Who Accept Assignment

Determining whether a healthcare provider accepts assignment is a proactive step to manage medical expenses. The most direct method is to contact the provider’s office or billing department before scheduling an appointment and ask about their assignment policy. This inquiry should clarify if they accept your specific insurance plan’s assignment or, for Medicare, if they accept Medicare assignment.

For those with private insurance, checking the insurance company’s online provider directory or contacting their customer service department can help identify providers who accept assignment. These resources often list in-network providers who have agreed to the insurer’s terms, which typically include accepting assignment.

Medicare beneficiaries have a dedicated tool called “Physician Compare” on Medicare.gov to find providers who accept assignment. This online directory allows users to search for doctors and other healthcare professionals and view their Medicare assignment status. Verifying this information can help patients avoid unexpected out-of-pocket costs.