assignment of benefit voucher

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Medicare Assignment: Everything You Need to Know

Medicare assignment.

• Providers Accepting Assignment
• Providers Who Do Not
• Billing Options
• Assignment of Benefits
• How to Choose

Frequently Asked Questions

Medicare assignment is an agreement between Medicare and medical providers (doctors, hospitals, medical equipment suppliers, etc.) in which the provider agrees to accept Medicare’s fee schedule as payment in full when Medicare patients are treated.

This article will explain how Medicare assignment works, and what you need to know in order to ensure that you won’t receive unexpected bills.

fizkes / Getty Images

There are 35 million Americans who have Original Medicare. Medicare is a federal program and most medical providers throughout the country accept assignment with Medicare. As a result, these enrollees have a lot more options for medical providers than most of the rest of the population.

They can see any provider who accepts assignment, anywhere in the country. They can be assured that they will only have to pay their expected Medicare cost-sharing (deductible and coinsurance, some or all of which may be paid by a Medigap plan , Medicaid, or supplemental coverage provided by an employer or former employer).

It’s important to note here that the rules are different for the 29 million Americans who have Medicare Advantage plans. These beneficiaries cannot simply use any medical provider who accepts Medicare assignment.

Instead, each Medicare Advantage plan has its own network of providers —much like the health insurance plans that many Americans are accustomed to obtaining from employers or purchasing in the exchange/marketplace .

A provider who accepts assignment with Medicare may or may not be in-network with some or all of the Medicare Advantage plans that offer coverage in a given area. Some Medicare Advantage plans— health maintenance organizations (HMOs) , in particular—will only cover an enrollee’s claims if they use providers who are in the plan's network.

Other Medicare Advantage plans— preferred provider organizations (PPOs) , in particular—will cover out-of-network care but the enrollee will pay more than they would have paid had they seen an in-network provider.

Original Medicare

The bottom line is that Medicare assignment only determines provider accessibility and costs for people who have Original Medicare. People with Medicare Advantage need to understand their own plan’s provider network and coverage rules.

When discussing Medicare assignment and access to providers in this article, keep in mind that it is referring to people who have Original Medicare.

How to Make Sure Your Provider Accepts Assignment

Most doctors, hospitals, and other medical providers in the United States do accept Medicare assignment.

Provider Participation Stats

According to the Centers for Medicare and Medicaid Services, 98% of providers participate in Medicare, which means they accept assignment.

You can ask the provider directly about their participation with Medicare. But Medicare also has a tool that you can use to find participating doctors, hospitals, home health care services, and other providers.

There’s a filter on that tool labeled “Medicare-approved payment.” If you turn on that filter, you will only see providers who accept Medicare assignment. Under each provider’s information, it will say “Charges the Medicare-approved amount (so you pay less out-of-pocket).”

What If Your Provider Doesn’t Accept Assignment?

If your medical provider or equipment supplier doesn’t accept assignment, it means they haven’t agreed to accept Medicare’s approved amounts as payment in full for all of the services.

These providers can still choose to accept assignment on a case-by-case basis. But because they haven’t agreed to accept Medicare assignment for all services, they are considered nonparticipating providers.

Note that "nonparticipating" does not mean that a provider has opted out of Medicare altogether. Medicare will still pay claims for services received from a nonparticipating provider (i.e., one who does not accept Medicare assignment), whereas Medicare does not cover any of the cost of services obtained from a provider who has officially opted out of Medicare.

If a Medicare beneficiary uses a provider who has opted out of Medicare, that person will pay the provider directly and Medicare will not be involved in any way.

Physicians Who Have Opted Out

Only about 1% of all non-pediatric physicians have opted out of Medicare.

For providers who have not opted out of Medicare but who also don’t accept assignment, Medicare will still pay nearly as much as it would have paid if you had used a provider who accepts assignment. Here’s how it works:

• Medicare will pay the provider 95% of the amount they would pay if the provider accepted assignment.
• The provider can charge the person receiving care more than the Medicare-approved amount, but only up to 15% more (some states limit this further). This extra amount, which the patient has to pay out-of-pocket, is known as the limiting charge . But the 15% cap does not apply to medical equipment suppliers; if they do not accept assignment with Medicare, there is no limit on how much they can charge the person receiving care. This is why it’s particularly important to make sure that the supplier accepts Medicare assignment if you need medical equipment.
• The nonparticipating provider may require the person receiving care to pay the entire bill up front and seek reimbursement from Medicare (using Form CMS 1490-S ). Alternatively, they may submit a claim to Medicare on behalf of the person receiving care (using Form CMS-1500 ).
• A nonparticipating provider can choose to accept assignment on a case-by-case basis. They can indicate this on Form CMS-1500 in box 27. The vast majority of nonparticipating providers who bill Medicare choose to accept assignment for the claim being billed.
• Nonparticipating providers do not have to bill your Medigap plan on your behalf.

Billing Options for Providers Who Accept Medicare

When a medical provider accepts assignment with Medicare, part of the agreement is that they will submit bills to Medicare on behalf of the person receiving care. So if you only see providers who accept assignment, you will never need to submit your own bills to Medicare for reimbursement.

If you have a Medigap plan that supplements your Original Medicare coverage, you should present the Medigap coverage information to the provider at the time of service. Medicare will forward the claim information to your Medigap insurer, reducing administrative work on your part.

Depending on the Medigap plan you have, the services that you receive, and the amount you’ve already spent in out-of-pocket costs, the Medigap plan may pay some or all of the out-of-pocket costs that you would otherwise have after Medicare pays its share.

(Note that if you have a type of Medigap plan called Medicare SELECT, you will have to stay within the plan’s network of providers in order to receive benefits. But this is not the case with other Medigap plans.)

After the claim is processed, you’ll be able to see details in your MyMedicare.gov account . Medicare will also send you a Medicare Summary Notice. This is Medicare’s version of an explanation of benefits (EOB) , which is sent out every three months.

If you have a Medigap plan, it should also send you an EOB or something similar, explaining the claim and whether the policy paid any part of it.

What Is Medicare Assignment of Benefits?

For Medicare beneficiaries, assignment of benefits means that the person receiving care agrees to allow a nonparticipating provider to bill Medicare directly (as opposed to having the person receiving care pay the bill up front and seek reimbursement from Medicare). Assignment of benefits is authorized by the person receiving care in Box 13 of Form CMS-1500 .

If the person receiving care refuses to assign benefits, Medicare can only reimburse the person receiving care instead of paying the nonparticipating provider directly.

Things to Consider Before Choosing a Provider

If you’re enrolled in Original Medicare, you have a wide range of options in terms of the providers you can use—far more than most other Americans. In most cases, your preferred doctor and other medical providers will accept assignment with Medicare, keeping your out-of-pocket costs lower than they would otherwise be, and reducing administrative hassle.

There may be circumstances, however, when the best option is a nonparticipating provider or even a provider who has opted out of Medicare altogether. If you choose one of these options, be sure you discuss the details with the provider before proceeding with the treatment.

You’ll want to understand how much is going to be billed and whether the provider will bill Medicare on your behalf if you agree to assign benefits (note that this is not possible if the provider has opted out of Medicare).

If you have supplemental coverage, you’ll also want to check with that plan to see whether it will still pick up some of the cost and, if so, how much you should expect to pay out of your own pocket.

A medical provider who accepts Medicare assignment is considered a participating provider. These providers have agreed to accept Medicare’s fee schedule as payment in full for services they provide to Medicare beneficiaries. Most doctors, hospitals, and other medical providers do accept Medicare assignment.

Nonparticipating providers are those who have not signed an agreement with Medicare to accept Medicare’s rates as payment in full. However, they can agree to accept assignment on a case-by-case basis, as long as they haven’t opted out of Medicare altogether. If they do not accept assignment, they can bill the patient up to 15% more than the Medicare-approved rate.

Providers who opt out of Medicare cannot bill Medicare and Medicare will not pay them or reimburse beneficiaries for their services. But there is no limit on how much they can bill for their services.

A Word From Verywell

It’s in your best interest to choose a provider who accepts Medicare assignment. This will keep your costs as low as possible, streamline the billing and claims process, and ensure that your Medigap plan picks up its share of the costs.

If you feel like you need help navigating the provider options or seeking care from a provider who doesn’t accept assignment, the Medicare State Health Insurance Assistance Program (SHIP) in your state may be able to help.

A doctor who does not accept Medicare assignment has not agreed to accept Medicare’s fee schedule as payment in full for their services. These doctors are considered nonparticipating with Medicare and can bill Medicare beneficiaries up to 15% more than the Medicare-approved amount.

They also have the option to accept assignment (i.e., accept Medicare’s rate as payment in full) on a case-by-case basis.

There are certain circumstances in which a provider is required by law to accept assignment. This includes situations in which the person receiving care has both Medicare and Medicaid. And it also applies to certain medical services, including lab tests, ambulance services, and drugs that are covered under Medicare Part B (as opposed to Part D).

In 2021, 98% of American physicians had participation agreements with Medicare, leaving only about 2% who did not accept assignment (either as a nonparticipating provider, or a provider who had opted out of Medicare altogether).

Accepting assignment is something that the medical provider does, whereas assignment of benefits is something that the patient (the Medicare beneficiary) does. To accept assignment means that the medical provider has agreed to accept Medicare’s approved fee as payment in full for services they provide.

Assignment of benefits means that the person receiving care agrees to allow a medical provider to bill Medicare directly, as opposed to having the person receiving care pay the provider and then seek reimbursement from Medicare.

Centers for Medicare and Medicaid Services. Medicare monthly enrollment .

Centers for Medicare and Medicaid Services. Annual Medicare participation announcement .

Centers for Medicare and Medicaid Services. Lower costs with assignment .

Centers for Medicare and Medicaid Services. Find providers who have opted out of Medicare .

Kaiser Family Foundation. How many physicians have opted-out of the Medicare program ?

Center for Medicare Advocacy. Durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) updates .

Centers for Medicare and Medicaid Services. Check the status of a claim .

Centers for Medicare and Medicaid Services. Medicare claims processing manual. Chapter 26 - completing and processing form CMS-1500 data set .

Centers for Medicare and Medicaid Services. Ambulance fee schedule .

Centers for Medicare and Medicaid Services. Prescription drugs (outpatient) .

By Louise Norris Norris is a licensed health insurance agent, book author, and freelance writer. She graduated magna cum laude from Colorado State University.

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Thanks for bulk billing! Now here’s some forms

5 minute read

The rules for patient consent to be bulk billed are good news for the doctors who love paperwork, bad news for the other 99.99%.

Doctors who want to bulk bill patients for a telehealth appointment have a compulsory new form to fill out documenting a patient’s verbal consent, courtesy of Services Australia.

The only other alternatives are getting written consent via email, privately billing the patient or running the risk of repaying all those benefits in the event of an audit.

To be clear, collecting a patient’s written consent to bulk bill has been a longstanding – if somewhat obscure – requirement under subsection 20B paragraph 3c of the Health Insurance Act 1973.

When telehealth was introduced over the pandemic, Services Australia made a temporary exception and allowed practitioners to get verbal consent from patients and simply make a note of it in the consult notes.

That exception was flagged as ending in December last year, but was extended at the last minute so the Department of Health and Aged Care could develop what the AMA said would be a “solution that is more suitable for permanent telehealth services”.

At the time, the medical association said it hoped the department would take the opportunity to “streamline arrangements” and reduce paperwork.

This particular wish does not appear to have been granted.

Under the new arrangements, doctors can still collect verbal consent to bulk bill – but they will have to follow it up by completing an online form which then has to be sent to the patient via email or text.

There are two approved forms to choose from: bulk bill voucher electronically transmitted claims form DB4E and assignment of benefit Medicare bulk bill webclaim form DB020 , the latter of which can only be used in conjunction with HPOS Medicare bulk bill webclaim.

Services Australia instructs doctors to type “patient verbally agreed” in the patient signature field of these forms, but only after discussing this with the patient .

Alternatively, GPs can email a patient to ask for written consent to bulk bill if they’ve done a telehealth appointment.

This is also a multi-step process.

First, the doctor needs to tell the patient during the consult that they plan to bulk bill.

Then, the doctor has to send an email to the patient’s nominated email address with the details of the service – including item numbers, benefit amounts and the date/time of service – the customer statement and a privacy notice.

Including the patient’s Medicare card number or the doctor’s provider number in this email is apparently a no-no, presumably for privacy reasons.

The patient then replies to that email, explicitly writing that they agree to the assignment of the Medicare benefit directly to the health professional.

Only once that is done can the doctor complete general, specialist and diagnostic assignment of benefit voucher form DB4 and submit the claim, writing “email agreement” in the signature block.

A copy of the form also must be sent to the patient.

The Albanese gov’t tripled GP incentives for bulk billing, woohoo! Now they introduce the requirement for a signed patient consent form in order to bulk bill a telehealth consultation! ??How is that meant to work? ? ?? #BulkBilling #TELEhealth #Medicare — Dr Rob Mathews (@robmathews) October 2, 2023

The third and final way to get bulk billing consent from a patient for a telehealth appointment is to obtain a physical signature via snail mail.

The new arrangements first appeared in a DOHAC fact sheet dated September 18 and took effect immediately.

In the fact sheet, DOHAC credited the new requirements to prove verbal consent to an Australian National Audit Office report on Medicare telehealth services released in January.

That ANAO report found that verbal consent for bulk billing created a fraud risk.

To spell it out: if there’s no patient acknowledgement that the consult being billed by the doctor actually happened, Services Australia could potentially be defrauded by GPs $38 at a time.

The ANAO also found that DOHAC officials had not only failed to properly assess the legal implications of verbal consent before putting it in place, but also outright ignored concerns from staff members about the potential for fraud as early as March 2020.

The report is about as snippy as official wording allows and takes the department to task for not clarifying to doctors that the verbal consent policy might not meet the legal requirement to provide patients with a copy of what they’re getting bulk billed for.

Bulk billing? You need the patient's signature

The consent rule half of GPs don’t know about

Bulk billing consent must be recorded in tapestry

“The legal consequences of failing to observe such requirements can be severe [for practitioners],” the ANAO wrote.

“Where a provider does not provide a copy of the signed agreement in approved form to the patient, there is no legal basis for Services Australia to pay the benefit to the provider.

“Additionally, providers can be criminally liable for failing to complete the agreement form properly.”

It led to a recommendation that DOHAC develop better procedures for structured and documented risk assessments whenever there’s a change to the MBS, which the department accepted.

Failure to have a signature from the patient acknowledging their consent to being bulk billed makes an entire claim non-compliant, meaning Medicare can theoretically demand repayment.

If it considers the non-compliant claims to be fraudulent in nature, there’s every chance that Medicare will also refer that doctor to the Commonwealth Director of Public Prosecutions.

DoHAC has reportedly assured the RACGP that no retrospective compliance will be carried out on this front.

Generally, however, doctors are advised to keep a copy of all correspondence, claims and forms for at least two years for auditing purposes.

College president Dr Nicole Higgins said she would raise the issue with DoHAC and Health Minister Mark Butler on behalf of members.

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Does the patient have to sign the bulk bill voucher?

Date of Answer: 12:06 pm  I  August 1, 2020

BB 2020/061

It is commonly believed that patients do not have to sign the bulk bill voucher. This is incorrect. The law is clear that the patient’s signature evidencing consent to bulk bill is always required.

This answer explains the law around the requirement for patients to sign the Bulk Bill voucher, commonly known as the DB4 form.

Relevant legislative provisions

Health Insurance Act 1973 , Section 20A

Health Insurance Act 1973 , Section 20B(3)

Health Insurance Act 1973 , Section 127

Health Insurance Regulations 2018, Reg 63(2)(b)

Electronic Transactions Act 1999

Other relevant materials

1. Short bulk bill explainer article published in Australian Doctor:

The Law Trumps Medicare Advice on Bulk Bill Vouchers: https://www.ausdoc.com.au/workwise/youre-likely-guilty-so-beware-law-trumps-medicare-advice-bulk-bill-vouchers

2. Peer reviewed academic journal article published in the Journal of Law and Medicine, with detailed analysis of bulk billing arrangements:

Medicare Billing Law and Practice: Complex, Incomprehensible and Beginning to Unravel. https://www.ncbi.nlm.nih.gov/pubmed/31682343

Wong v Commonwealth of Australia;  Selim v Lele, Tan and Rivett constituting the Professional Services Review Committee No 309 [2009] HCA 3 (2 February 2009) 

Departmental interpretation

https://www.servicesaustralia.gov.au/organisations/health-professionals/services/medicare/medicare-online-health-professionals (accessed 6 June 2020)

“Assignment of benefit documents

Assignment of benefit forms no longer need to be stored at the practice if you are using Medicare Online. ..

The legislative requirements for the assignment of benefit are:

• an agreement must be made between the patient (assignor) and you for the assignment of benefit
• the agreement is evidenced through the use of the assignment of benefit form
• the patient is required to sign the form
• a copy of the agreement must be provided to the patient.”

Detailed reasoning

Section 20A(1) of the Health Insurance Act (the Act) describes the bulk billing process as follows (my underlining):

“Assignment of Medicare benefit

(1)  Where a medicare benefit is payable to an eligible person in respect of a professional service rendered to the eligible person or to another eligible person, the first‑mentioned eligible person and the person by whom, or on whose behalf, the professional service is rendered (in this subsection referred to as the practitioner) may enter into an agreement, in accordance with the approved form, under which:

(a)  the first‑mentioned eligible person assigns his or her right to the payment of the medicare benefit to the practitioner; and

(b)  the practitioner accepts the assignment in full payment of the medical expenses incurred in respect of the professional service by the first‑mentioned eligible person.”

There are two parties described in Section 20A. The first is the ‘eligible person’ which is the patient, and the second is the ‘practitioner’ which may be a doctor or any health provider able to claim using the medicare scheme.

Section 20A states that the patient holds the legal right to the medicare benefit, not the practitioner. A simple two step process (known as bulk billing) is set out, whereby the patient assigns their right to a medicare benefit to the practitioner, and the practitioner accepts it in full payment for the service provided.

Implicit in this arrangement is the concept of consent.

In deliberations around the operation of Section 20A, Kirby J, in the High Court case of Wong v Commonwealth of Australia said:

“Even “bulk billing” is only possible by consent of both parties to that relationship.”

The method of consent is described in Section 20B(3) of the Act. This is where the patient’s signature comes into play. The Act states that the patient has to sign the assignment of benefit form to evidence their consent to being bulk billed.

Here is section 20B(3) with the word ‘signed’ underlined.

“(3)  A claim referred to in subsection (2) shall not be paid unless the claimant satisfies the Chief Executive Medicare that:

(c)  in the case of an agreement under subsection 20A(1) that was signed by each party in the presence of the other—the assignor retained in his or her possession after the agreement was so signed a copy of the agreement;”

The content on the Department’s website (above, under the heading Departmental Interpretation) is likely the cause of widespread non-compliance with the signature requirement, because it is confusing.

However, it is important to understand that the department saying you do not have to keep the signed form, does not mean the patient does not have to sign it.

The law is clear – the patient has to sign the assignment of benefit form to evidence consent, and the fact that the department permits putting your copy of the signed form in the bin, in no way negates the provisions of the Act.

From the government perspective, continuance of the signature requirement is good policy, designed to protect the integrity of public money, in two ways:

• It is the only active involvement the patient has in a bulk billing transaction, and it therefore provides the only opportunity for the patient to review and query the services being claimed against her/his Medicare number, and
• It is a critically important safeguard against fraudulent billing (such as billing for fictitious services) because it is the only evidence of both the practitioner and patient being in the same place at the same time.

From the practitioner perspective, retaining copies of signed bulk bill vouchers is a good idea, because it evidences practitioner presence and patient consent. Entries in clinical records cannot do this to the same extent. For example, an unethical practitioner could easily make an entry in a clinical record for an existing patient, without having provided a service, and the patient would likely never know that a claim had been bulk billed under their Medicare card.

The department’s position is unfortunate, however, it is there in black and white on their website. So, if you are bulk billing electronically, the department has made clear, the decision to retain or bin signed bulk bill vouchers is a matter for you.

Section 20A and 20B are two of the key machinery provisions of the Act, underpinning the operation of the Medicare scheme. Think of them like pulmonary veins that deliver oxygenated blood to the heart. These sections deliver approved payments of taxpayer’s money to your pocket. Removing them from the scheme would obliterate patient consent and render the scheme more vulnerable to abuse.

Examples and other relevant information

Other important legal provisions relating to bulk billing that you should be aware of.

• Asking patients to sign blank bulk bill forms or forms with missing details is illegal per Section 127 of the Act .
• Not giving patients a copy of their signed bulk bill form is an offence, but penalties can be waived if you have a ‘reasonable excuse’ as to why you didn’t give it to the patient. This is also in Section 127.
• Using a Medicare Easyclaim terminal has a special legal provision, so having the patient (not you) press ‘yes or ‘OK’ on the terminal is a legally valid signature, per regulation 63(2)(b).
• If the patient is unable to sign, you can indicate ‘unable to sign’ and notate why. This has always been an available option on the prescribed form (the DB4).
• Medicare is a fee-for-service scheme meaning you must obtain the patient’s consent for each separate service. It is not permissible to obtain a blanket ongoing consent to bulk bill, such as for a course of chemotherapy.
• The Department is bound by the provisions of the Electronic Transactions Act 1999 and so SMS/email signatures are permitted, providing certain criteria are met. This will help you to understand how to manage the bulk bill signature requirement in situations where the patient is not physically in the same place as the practitioner when the service is provided, such as case conferences and telehealth. See answer BB2020/062 .

Who this applies to

Everyone when bulk billing.

When this applies

Always. This has been the law since Medibank (later Medicare) began.

Relevant AIMAC courses

Bulk Billing, Medicare’s Heart Beat

Date of Answer: 1:37 pm  I  September 21, 2020

• Bulk billing is only permissible AFTER a service has been provided and fees have been incurred in respect of a professional service. Therefore, do not ever ask a patient to sign a bulk bill voucher (even if all data elements have been completed) before a service has been provided. Patients cannot be asked to sign for a service they have not received.

Date of Answer: 5:54 pm  I  January 16, 2023

Date of Answer: 1:52 pm  I  February 23, 2023

Health Insurance Act 1973 , Section 20B(3)

Health Insurance Act 1973 , Section 127

2. Academic journal article published in the Journal of Law and Medicine, with detailed analysis of bulk billing arrangements:

Wong v Commonwealth of Australia;  Selim v Lele, Tan and Rivett constituting the Professional Services Review Committee No 309 [2009] HCA 3 (2 February 2009) 

(1)  Where a medicare benefit is payable to an eligible person in respect of a professional service rendered to the eligible person or to another eligible person, the first‑mentioned eligible person and the person by whom, or on whose behalf, the professional service is rendered (in this subsection referred to as the practitioner) may enter into an agreement, in accordance with the approved form, under which:

(a)  the first‑mentioned eligible person assigns his or her right to the payment of the medicare benefit to the practitioner; and

(b)  the practitioner accepts the assignment in full payment of the medical expenses incurred in respect of the professional service by the first‑mentioned eligible person.”

“(3)  A claim referred to in subsection (2) shall not be paid unless the claimant satisfies the Chief Executive Medicare that:

(c)  in the case of an agreement under subsection 20A(1) that was signed by each party in the presence of the other—the assignor retained in his or her possession after the agreement was so signed a copy of the agreement;”

Date of Answer: 3:51 pm  I  March 1, 2023

Date of Answer: 2:27 pm  I  May 15, 2023

Date of Answer: 3:14 pm  I  June 5, 2023

Whether patients need to sign something when being bulk billed causes a great deal of confusion industry wide. The confusion is understandable given Medicare itself advises that you do not need to retain signed bulk bill vouchers. But what does that actually mean and what does the law say?

Date of Answer: 3:15 pm  I  June 5, 2023

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Assignment of Benefits: What It Is, and How It Can Affect your Property Insurance Claim

Table of Contents

What is an Assignment of Benefits?

In the context of insured property claims, an assignment of benefits (AOB) is an agreement between you and a contractor in which you give the contractor your right to insurance payments for a specific scope of work .  In exchange, the contractor agrees that it will not seek payment from you for that scope of work, except for the amount of any applicable deductible.  In other words, you give part of your insurance claim to your contractor, and your contractor agrees not to collect from you for part of its work.

The most important thing to know about an assignment of benefits is that it puts your contractor in control your claim , at least for their scope of work.  Losing that control can significantly affect the direction and outcome of your claim, so you should fully understand the implications of an AOB (sometimes called an assignment of claims or AOC) before signing one.

How Does an Assignment of Benefits Work in Practice? 

Let’s say you’re an insured homeowner, and Hurricane Ian significantly damaged your roof.  Let’s also assume your homeowner’s policy covers that damage.  A roofer, after inspecting your roof and reviewing your insurance policy, might conclude that your insurer is probably going to pay for a roof replacement under your insurance policy.  The only problem is that it’s early in the recovery process, and your insurer hasn’t yet stated whether it will pay for the roof replacement proposed by your contractor. So if you want your roof replaced now, you would ordinarily agree to pay your roofer for the replacement, and wait in hopes that your insurer reimburses you for the work.  This means that if your insurance company refuses to pay or drags out payment, you’re on the hook to your roofer for the cost of the replacement.

As an alternative to agreeing to pay your roofer for the full cost of the work, you could sign an assignment of benefits for the roof replacement.  In this scenario, your roofer owns the part of your insurance claim that pertains to the roof replacement.  You might have to pay your roofer for the amount of your deductible, but you probably don’t have to pay them for the rest of the cost of the work.  And if your insurance company refuses to pay or drags out payment for the roof replacement, it’s your roofer, and not you, who would be on the hook for that shortfall.

So should you sign an AOB?  Not necessarily.  Read below to understand the pros and cons of an assignment of benefits.

Are There any Downsides to Signing an Assignment of Benefits?

Yes.  

You lose control of your claim . This is the most important factor to understand when considering whether to sign an AOB.  An AOB is a formal assignment of your legal rights to payment under your insurance contract.  Unless you’re able to cancel the AOB, your contractor will have full control over your claim as it relates to their work. 

To explain why that control could matter, let’s go back to the roof replacement example.  When you signed the AOB, the scope of work you agreed on was to replace the roof.  But you’re not a roofing expert, so you don’t know whether the costs charged or the materials used by the roofer in its statement of work are industry appropriate or not.  In most cases, they probably are appropriate, and there’s no problem.  But if they’re not – if, for instance, the roofer’s prices are unreasonably high – then the insurer may not approve coverage for the replacement.  At that point, the roofer could lower its prices so the insurer approves the work, but it doesn’t have to, because it controls the claim .  Instead it could hold up work and threaten to sue your insurer unless it approves the work at the originally proposed price.  Now the entire project is insnared in litigation, leaving you in a tough spot with your insurer for your other claims and, most importantly, with an old leaky roof.

Misunderstanding the Scope of Work.   Another issue that can arise is that you don’t understand the scope of the assignment of benefits.  Contractor estimates and scopes of work are often highly technical documents that can be long on detail but short on clarity.  Contractors are experts at reading and writing them.  You are not.  That difference matters because the extent of your assignment of benefits is based on that technical, difficult-to-understand scope of work.  This can lead to situations where your understanding of what you’re authorizing the contractor to do is very different from what you’ve actually authorized in the AOB agreement.

In many cases, it’s not necessary .   Many contractors will work with you and your insurer to provide a detailed estimate of their work, and will not begin that work until your insurer has approved coverage for it.  This arrangement significantly reduces the risk of you being on the hook for uninsured repairs, without creating any of the potential problems that can occur when you give away your rights to your claim.

Do I have to sign an Assignment of Benefits?

No.  You are absolutely not required to sign an AOB if you do not want to. 

Are There any Benefits to Signing an Assignment of Benefits?

Potentially, but only if you’ve fully vetted your contractor and your claim involves complicated and technical construction issues that you don’t want to deal with. 

First, you must do your homework to fully vet your contractor!  Do not just take their word for it or be duped by slick ads.  Read reviews, understand their certificate of insurance, know where they’re located, and, if possible, ask for and talk to references.  If you’ve determined that the contractor is highly competent at the work they do, is fully insured, and has a good reputation with customers, then that reduces the risk that they’ll abuse their rights to your claim.

Second, if your claim involves complicated reconstruction issues, a reputable contractor may be well equipped to handle the claim and move it forward.  If you don’t want to deal with the hassle of handling a complicated claim like this, and you know you have a good contractor, one way to get rid of that hassle is an AOB.

Another way to get rid of the hassle is to try Claimly, the all-in-one claims handling tool that get you results but keeps you in control of your claim.  

Can my insurance policy restrict the use of AOBs?

Yes, it’s possible that your Florida insurance policy restricts the use of AOBs, but only if all of the following criteria are met:

• When you selected your coverage, your insurer offered you a different policy with the same coverage, only it did not restrict the right to sign an AOB.
• Your insurer made the restricted policy available at a lower cost than the unrestricted policy.
• If the policy completely prohibits AOBs, then it was made available at a lower cost than any policy partially prohibiting AOBs.
• The policy includes on its face the following notice in 18-point uppercase and boldfaced type:

THIS POLICY DOES NOT ALLOW THE UNRESTRICTED ASSIGNMENT OF POST-LOSS INSURANCE BENEFITS. BY SELECTING THIS POLICY, YOU WAIVE YOUR RIGHT TO FREELY ASSIGN OR TRANSFER THE POST-LOSS PROPERTY INSURANCE BENEFITS AVAILABLE UNDER THIS POLICY TO A THIRD PARTY OR TO OTHERWISE FREELY ENTER INTO AN ASSIGNMENT AGREEMENT AS THE TERM IS DEFINED IN SECTION 627.7153 OF THE FLORIDA STATUTES.

627.7153. 

Pro Tip : If you have an electronic copy of your complete insurance policy (not just the declaration page), then search for “policy does not allow the unrestricted assignment” or another phrase from the required language above to see if your policy restricts an AOB.  If your policy doesn’t contain this required language, it probably doesn’t restrict AOBs.

Do I have any rights or protections concerning Assignments of Benefits?

Yes, you do.  Florida recently enacted laws that protect consumers when dealing with an AOB.

Protections in the AOB Contract

To be enforceable, a Assignments of Benefits must meet all of the following requirements:

• Be in writing and executed by and between you and the contractor.
• Contain a provision that allows you to cancel the assignment agreement without a penalty or fee by submitting a written notice of cancellation signed by the you to the assignee:
• at least 30 days after the date work on the property is scheduled to commence if the assignee has not substantially performed, or
• at least 30 days after the execution of the agreement if the agreement does not contain a commencement date and the assignee has not begun substantial work on the property.
• Contain a provision requiring the assignee to provide a copy of the executed assignment agreement to the insurer within 3 business days after the date on which the assignment agreement is executed or the date on which work begins, whichever is earlier.
• Contain a written, itemized, per-unit cost estimate of the services to be performed by the assignee .
• Relate only to work to be performed by the assignee for services to protect, repair, restore, or replace a dwelling or structure or to mitigate against further damage to such property.
• Contain the following notice in 18-point uppercase and boldfaced type:

YOU ARE AGREEING TO GIVE UP CERTAIN RIGHTS YOU HAVE UNDER YOUR INSURANCE POLICY TO A THIRD PARTY, WHICH MAY RESULT IN LITIGATION AGAINST YOUR INSURER. PLEASE READ AND UNDERSTAND THIS DOCUMENT BEFORE SIGNING IT. YOU HAVE THE RIGHT TO CANCEL THIS AGREEMENT WITHOUT PENALTY WITHIN 14 DAYS AFTER THE DATE THIS AGREEMENT IS EXECUTED, AT LEAST 30 DAYS AFTER THE DATE WORK ON THE PROPERTY IS SCHEDULED TO COMMENCE IF THE ASSIGNEE HAS NOT SUBSTANTIALLY PERFORMED, OR AT LEAST 30 DAYS AFTER THE EXECUTION OF THE AGREEMENT IF THE AGREEMENT DOES NOT CONTAIN A COMMENCEMENT DATE AND THE ASSIGNEE HAS NOT BEGUN SUBSTANTIAL WORK ON THE PROPERTY. HOWEVER, YOU ARE OBLIGATED FOR PAYMENT OF ANY CONTRACTED WORK PERFORMED BEFORE THE AGREEMENT IS RESCINDED. THIS AGREEMENT DOES NOT CHANGE YOUR OBLIGATION TO PERFORM THE DUTIES REQUIRED UNDER YOUR PROPERTY INSURANCE POLICY.

• Contain a provision requiring the assignee to indemnify and hold harmless the assignor from all liabilities, damages, losses, and costs, including, but not limited to, attorney fees.

Contractor Duties

Under Florida law, a contractor (or anyone else) receiving rights to a claim under an AOB:

• Must provide you with accurate and up-to-date revised estimates of the scope of work to be performed as supplemental or additional repairs are required.
• Must perform the work in accordance with accepted industry standards.
• May not seek payment from you exceeding the applicable deductible under the policy unless asked the contractor to perform additional work at the your own expense.
• Must, as a condition precedent to filing suit under the policy, and, if required by the insurer, submit to examinations under oath and recorded statements conducted by the insurer or the insurer’s representative that are reasonably necessary, based on the scope of the work and the complexity of the claim, which examinations and recorded statements must be limited to matters related to the services provided, the cost of the services, and the assignment agreement.
• Must, as a condition precedent to filing suit under the policy, and, if required by the insurer, participate in appraisal or other alternative dispute resolution methods in accordance with the terms of the policy.
• If the contractor is making emergency repairs, the assignment of benefits cannot exceed the greater of $3,000 or 1% of your Coverage A limit.

Recommended Posts

Florida’s 2023 legislative session: more big changes to insurance claim laws, the florida contractor’s guide to aobs: laws, requirements, and faqs, faqs: everything you need to know about additional living expenses insurance coverage.

Brelly’s tools and resources are your secret weapon to getting your insurance claim filed right, moving fast, and paid fully .

Assignment of benefits

Assignment of benefits is a legal agreement where a patient authorizes their healthcare provider to receive direct payment from the insurance company for services rendered.

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What is Assignment of Benefits?

Assignment of benefits (AOB) is a crucial concept in the healthcare revenue cycle management (RCM) process. It refers to the legal transfer of the patient's rights to receive insurance benefits directly to the healthcare provider. In simpler terms, it allows healthcare providers to receive payment directly from the insurance company, rather than the patient being responsible for paying the provider and then seeking reimbursement from their insurance company.

Understanding Assignment of Benefits

When a patient seeks medical services, they typically have health insurance coverage that helps them pay for the cost of their healthcare. In most cases, the patient is responsible for paying a portion of the bill, known as the copayment or deductible, while the insurance company covers the remaining amount. However, in situations where the patient has assigned their benefits to the healthcare provider, the provider can directly bill the insurance company for the services rendered.

The assignment of benefits is a legal agreement between the patient and the healthcare provider. By signing this agreement, the patient authorizes the healthcare provider to receive payment directly from the insurance company on their behalf. This ensures that the provider receives timely payment for the services provided, reducing the financial burden on the patient.

Difference between Assignment of Benefits and Power of Attorney

While the assignment of benefits may seem similar to a power of attorney (POA) in some respects, they are distinct legal concepts. A power of attorney grants someone the authority to make decisions and act on behalf of another person, including financial matters. On the other hand, an assignment of benefits only transfers the right to receive insurance benefits directly to the healthcare provider.

In healthcare, a power of attorney is typically used in situations where a patient is unable to make decisions about their medical care. It allows a designated individual, known as the healthcare proxy, to make decisions on behalf of the patient. In contrast, an assignment of benefits is used to streamline the payment process between the healthcare provider and the insurance company.

Examples of Assignment of Benefits

To better understand how assignment of benefits works, let's consider a few examples:

Sarah visits her primary care physician for a routine check-up. She has health insurance coverage through her employer. Before the appointment, Sarah signs an assignment of benefits form, authorizing her physician to receive payment directly from her insurance company. After the visit, the physician submits the claim to the insurance company, and they reimburse the physician directly for the covered services.

John undergoes a surgical procedure at a hospital. He has health insurance coverage through a private insurer. Prior to the surgery, John signs an assignment of benefits form, allowing the hospital to receive payment directly from his insurance company. The hospital submits the claim to the insurance company, and they reimburse the hospital for the covered services. John is responsible for paying any copayments or deductibles directly to the hospital.

Mary visits a specialist for a specific medical condition. She has health insurance coverage through a government program. Mary signs an assignment of benefits form, granting the specialist the right to receive payment directly from the government program. The specialist submits the claim to the program, and they reimburse the specialist for the covered services. Mary is responsible for any applicable copayments or deductibles.

In each of these examples, the assignment of benefits allows the healthcare provider to receive payment directly from the insurance company, simplifying the billing and reimbursement process for both the provider and the patient.

Assignment of benefits is a fundamental concept in healthcare revenue cycle management. It enables healthcare providers to receive payment directly from the insurance company, reducing the financial burden on patients and streamlining the billing process. By understanding the assignment of benefits, patients can make informed decisions about their healthcare and ensure that their providers receive timely payment for the services rendered.

Improve your financial performance while providing a more transparent patient experience

Related terms, payer identifier.

Payer identifier is a unique alphanumeric code assigned to healthcare payers, such as insurance companies or government programs, for identification and billing purposes.

Deductible is the predetermined amount that an insured individual must pay out of pocket for covered healthcare services before insurance coverage begins.

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Social Security

Program operations manual system (poms).

TN 35 (04-14)

GN 02410.001 Assignment of Benefits

A.  protection from assignment of benefits.

Sections 207 and 1631(d)(1) of the Social Security Act (the Act) prohibit “transfer” or “assignment” of a beneficiary or recipient’s right to future payment under title II and title XVI respectively. These sections of the Act prohibit the transfer of control over money to someone other than the beneficiary, recipient, or the representative payee. These sections also protect the beneficiary or recipient's right to receive payments directly, and to choose how to use the payments.

Our responsibility for protecting payments against legal process and assignment ends when we pay the beneficiary or recipient. However, once paid, Sections 207 and 1631(d)(1) of the Act continue to protect payments as long as we can identify them as:

Retirement, Survivors and Disability Insurance (RSDI) benefits; or

Supplemental Security Income (SSI) payments.

For example, this would include a situation in which RSDI or SSI payments are the only direct deposit payments in the account.

A beneficiary or recipient can use Sec. 207 or 1631(d)(1) of the Act as a personal defense if ordered to pay his or her payments to someone else, or if his or her payments are ordered to be taken by legal process.

B.  Exceptions to protection from assignment of benefits

Laws may create exceptions to the protections provided under Sec. 207 and 1631 of the Act, but only if they explicitly identify the applicable section, either Sec. 207 or 1631 (also found in the United States Code as 42 USC 407 or 42 USC 1383), and provide that the law applies despite that section. So far, Congress has authorized the following exceptions to Sec. 207 and 1631 of the Act.

1.  Garnishment of benefit payments for child support or alimony

Garnishment is the legal process of withholding an amount from money owed to a person in order to pay off the person’s debt to another. Under Sec.459 of the Act (42 USC 659), garnishment of benefit payments for the purpose of collecting amounts owed for child support or alimony is permitted. For policy on garnishment of title II benefits, see GN 02410.200 through GN 02410.225 .

2.  Garnishment of benefit payments for victim restitution

Garnishment of benefit payments to recover court-ordered victim restitution is permitted under 18 USC 3613(a), 3663, 3663A, and 3664. For policy on garnishment for court-ordered victim restitution, see GN 02410.223 .

3.  Levy for unpaid federal taxes

Levy is the legal seizure of property, such as Social Security benefit payments, to recover a debt. The IRS places a levy on benefit payments to recover unpaid federal taxes under 26 USC 6331 and 6334. For policy on IRS levy, see GN 02410.100 .

C.  Fees and automatic withdrawals

State or Federal government guidelines do not regulate financial institution (FI) fees. These fees are a matter of contract between banks and their customers. Customary fees outlined in account contracts with FIs, and the automatic withdrawal of these fees, do not constitute an assignment of benefits. For a definition of an acceptable FI, see GN 02402.030 .

1.  Financial institution

The following banking options meet Treasury’s definition of an acceptable FI:

Savings and loan associations,

Credit unions, or

Thrift institutions.

For policy on acceptable financial institutions, see GN 02402.030 .

NOTE : A master sub-account is an account at an FI established to receive deposits on behalf of a group of individuals. Sub-accounts are then set up at the same FI, another FI, or on the individual ledgers maintained by the master account holder. An acceptable master sub-account relationship is not an assignment of benefits. For policy on acceptable master sub-account relationships, see GN 02402.050 .

2.  Account fees

We do not prohibit automatic withholding of account fees from accounts holding SSA payments when those fees are customary to accounts with the FI.

A fee is “customary” if it is consistent with fees associated with similar accounts at the FI and the same fees apply to both federal and non-federal deposits.

NOTE : We should question fees that apply only to federal payments. If the FI applies different fees to federal and similar non-federal deposits, send the issue in question to the Regional Office (RO).

3.  Pre-authorized withdrawals

A beneficiary recipient, or his or her representative payee, may pre-authorize an FI, or other entity, to withdraw funds from his or her account for a wide variety of purposes (e.g., utility bills, mortgage payments, loan repayments, investments, nursing home fees, etc.). Once the beneficiary recipient, or his or her representative payee, establishes control by receipt and deposit of the payment, these arrangements are allowed, provided they can be terminated at any time. Terminating the arrangement does not mean terminating or canceling the debt. It means that the beneficiary recipient, or his or her representative payee, may terminate the pre-authorized withdrawal arrangement as a method for paying the debt. The right to receive and to choose how to use those payments exists if the beneficiary recipient, or his or her representative payee, can freely terminate this arrangement. If a beneficiary recipient, or his or her representative payee, cannot freely revoke the pre-authorized withdrawal, send the issue in question to the RO.

D.  Prohibited arrangements versus acceptable relationships

The beneficiary recipient’s, or his or her representative payee’s, control of the receipt and use of payments will determine if a payment arrangement is prohibited or acceptable.

1.  Prohibited arrangements

A.  payment to the wrong person.

Do not make payment to any person or entity other than the beneficiary recipient, or his or her representative payee, except as outlined in GN 02410.001B and GN 02410.001C in this section. This prohibition applies regardless of the person or entity who makes the request.

For example, the prohibition applies when:

a beneficiary or recipient requests that we pay his or her payments to someone other than the beneficiary or the beneficiary’s representative payee.

a court orders SSA to make payment to a party other than the beneficiary or recipient, unless one of the specific exceptions in GN 02410.001B in this section exists. For policy on when SSA should not comply with a bankruptcy court’s order to pay benefits to a bankruptcy trustee, see GN 02410.005 .

When you are unable to determine whether there is a prohibited arrangement, send the issue in question to the RO.

b.  Other prohibited arrangements

Even if the payment goes directly to the beneficiary or recipient (or the representative payee), the arrangement may is prohibited if the beneficiary or recipient surrenders control of the payments. Avoid any arrangement where the beneficiary or recipient surrenders or shares control of payments with a person or entity that has an interest in charging or collecting money from the beneficiary or recipient.

Avoid the following situations:

Do not approve sending a payment, either by check or electronically, to a loan company where the beneficiary or recipient has a loan, or to a party holding the beneficiary or recipient's power of attorney. For information on power of attorney, see GN 02410.010 .

Do not approve a bank account when the attorney or non-attorney representative has the power to withdraw funds so that representative’s fees can be collected directly from that beneficiary or recipient’s account. See the note in GN 03920.025A . For policy on unacceptable requests for direct deposit, see GN 02402.085 .

In both scenarios given, the arrangement is prohibited because the beneficiary or recipient surrenders control over the payment.

When you are unsure of a prohibited arrangement, send the issue in question to the RO.

2.  Acceptable relationships

A.  third-party repayment.

Third parties may employ representatives to ensure that beneficiaries or recipients repay debts owed to the third parties immediately after the beneficiary or recipient starts to receive payment. This arrangement is acceptable if:

The third-party representative has no financial interest in the beneficiary or recipient’s direct deposit account (i.e., he is not named on the account and has no authority to direct the money in the account);

The third party representative is not charging the beneficiary or recipient a fee;

The beneficiary or recipient pre-authorizes, (according to the financial institution’s policy), a withdrawal of funds from his account to repay a debt to a third party;

The third-party representative did not obtain the pre-authorization from the beneficiary or recipient through deceit, coercion, or intimidation; and

The third-party representative gets oral or written confirmation from the beneficiary or recipient of the pre-authorization to withdraw the money from the account after we deposit funds into the beneficiary or recipient’s account and before a transfer of funds to pay the third party debt.

NOTE : Confirmation is necessary because a beneficiary or recipient may have signed the pre-authorization before learning whether he or she will receive benefits and the amount of past-due benefits he or she will receive. In this situation, confirmation prevents the third party from taking funds before the beneficiary or recipient exercises control over the funds.

b.  Financial institution-electronic funds distributor (FI-EFD) accounts

Some FI have established Electronic Funds Distributor (EFD) relationships with various check cashing establishments to receive and distribute monthly direct deposit payments to assist SSA beneficiaries or recipients who do not have traditional bank accounts.

The FI receives the monthly payment by direct deposit titled under the beneficiary or recipient’s name. Then, the FI electronically transfers payment to the contracted EFD. The EFD, acting as an agent of the FI, will then release the monthly payment to the account holder in the form of a cashier’s check.

These FI-EFD accounts are acceptable and not prohibited if they meet the following requirements:

The FI must be acceptable under United States Treasury guidelines. (For policy on acceptable types of financial institutions, see GN 02402.030A .)

The EFD must have a contract with and act as an agent of the FI.

The FI account must be acceptable as outlined in GN 02402.030 B.1 .

A secondary contract relationship that attaches the FI-EFD transaction account as collateral for loan fees associated with the EFD cannot exist as a requirement for participation between the EFD and the beneficiary or recipient.

No person or entity can have control over the receipt, or use of, SSA benefit payments other than the beneficiary or his or her representative payee. (For Assignment of Benefits, see GN 02410.001 and Sec.1631 (d)(1).)

The beneficiary, recipient, or representative payee may cancel his or her FI-EFD direct deposit arrangement at any time.

Fees associated with the account must be customary to fees for similar accounts at the FI and those fees are outlined in the FI-customer contract.

When you are unable to clearly determine whether an FI-EFD account is acceptable, send the issue in question to the RO.

E.  Examples of acceptable and prohibited relationships

1.  acceptable relationship.

A company pays long-term disability (LTD) benefits to a customer and requires them to file for Social Security title II benefits. When the Social Security claim is allowed, the amount of Social Security benefits received offsets the LTD benefit amount. As an incentive to induce the LTD insurer to refer claimants, the claimant’s LTD representative offers to assist the insurer with recovering the overpayment the insurer made to the claimant. The LTD representative does not charge the claimant a fee for this service. The LTD representative also makes it clear to the claimant that he or she may pay the LTD directly and does not have to pay the LTD through the representative.

At the LTD representative’s request, the claimant gives the representative pre-authorization to withdraw funds from the claimant’s bank account if SSA approves the claim and issues the claimant past-due benefits.

After we approve the claim and deposit the past-due benefits into the claimant’s account, the LTD representative gets oral authorization (in addition to the pre-authorization) to transfer those funds to the LTD insurer to satisfy the LTD overpayment. The LTD representative also documents the oral authorization. We will accept this arrangement. The beneficiary is exercising control over the past-due benefits deposited into his or her account before the pre-authorized transfer of funds, and the beneficiary understands that he or she could have elected to pay the LTD directly. The LTD provider does not receive a fee from the beneficiary and obtains a pre-authorization to transfer funds from the beneficiary’s account in order to repay the third party (i.e., the overpayment of payments from the insurer). The LTD representative also gets authorization after deposit of the SSA benefit payment into the beneficiary’s account. For policy on acceptable third-party repayment arrangements, see GN 02410.001D.2.a. , in this section.

b.  Master sub-account

Comfort Nursing Home maintains a master sub-account titled “Comfort Nursing Home Patients' Accounts” at New State Bank for the convenience of its residents. The nursing home sets up a separate sub-account for each resident. Residents sign agreements for the nursing home to withdraw monthly amounts for care costs. Residents can withdraw any amount, up to the balance in their accounts for personal expenses and they have the right to terminate the account at any time. The nursing home keeps track of all deposits and withdrawals. This is an acceptable master sub-account. For policy on acceptable master sub-accounts with FI, see GN 02402.050 .

c.  FI-EFD

Big Bucks Bank Inc. (BBB) is an accepted FI. BBB offers the “We-Pay-U” program for customers without traditional bank accounts. We-Pay-U program customers sign a contract and establish a non-interest bearing account with BBB for the sole purpose of electronic transfer of federal or non-federal monthly payments to that account. Beneficiaries or recipients can then receive their SSA payments in the form of a cashier's check from Brown Bear Check Cashing. Brown Bear Check Cashing acts as an agent of BBB and must adhere to the rules and regulations of BBB in relation to the We-Pay-U account. The We-Pay-U customer agrees to a monthly processing fee associated with the We-Pay-U account, which BBB withdraws from their payment automatically. This is an acceptable relationship. The beneficiary or recipient has established control of their payment and the fees associated with the We-Pay-U program. Because the account fees in the contract apply to both federal and non-federal monthly payments, we consider them customary to the BBB account. For policy on acceptable FI-EFD arrangements, see GN 02410.001D.2.b. in this section.

2.  Prohibited arrangement

A beneficiary or recipient has appointed an attorney representative to help him in proceedings before SSA. SSA is not paying an attorney fee directly to the representative. The beneficiary or recipient establishes a checking account in his or her own name that requires the signature of both the beneficiary or recipient and the attorney on checks written to withdraw funds from the account. The beneficiary or recipient requests direct deposit of his or her payments to that account. This is a prohibited arrangement because the beneficiary or recipient has given control of access to payments to the attorney representative. See the following references for additional information:

For policy on Who is a Representative, see GN 03910.020 .

For policy on representative’s fees in trust or escrow accounts, see GN 03920.025 .

For policy on acceptable types of financial institutions and accounts, see GN 02402.030 .

For policy on payment to the wrong person, see GN 02410.001D.1. , in this section.

F.  References

GN 02402.030 Acceptable Types of Financial Institutions and Accounts

GN 02402.050 Account Titles

GN 02402.085 Unacceptable Requests for Direct Deposit

GN 03910.020 Who Is a Representative

GN 03920.017 Payment of Representative's Fee

GN 03920.025 Representative's Fee - Trust or Escrow Accounts

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Membership & Benefits

Assignment of Benefit

GPs and their practice staff are reminded that when processing bulk bill claims though Medicare Easyclaim that the patient must physically assign their benefit as full payment for the service. The Department of Human Services in its latest News for Health Professionals advises that for the assignment of benefit you need to:

• use the assignment of benefit form to show evidence of your agreement with the patient
• get the patient to sign the form
• provide the patient with a copy of the agreement
• press OK on the EFTPOS terminal
• or to sign an approved DB4 form if the EFTPOS terminal system is unavailable

Related topics

More across the ama.

Assignment of benefits: A growing concern

By Kevin Poll

Evaluating claims properly and determining the appropriate amount of a loss are crucial for insurance companies, especially when trying to offer competitive premiums to customers and maintain profitable financial results.

Factors that affect profitability

In the business of insurance, many factors—some that can’t be controlled—affect financial profitability. Predictive analytics and more refined modeling are helping insurers reduce uncertainty, but even the best of models have their limitations.

Further, many variables can’t be predicted but could have significant financial impact on the bottom line. One of those variables—the potential for the benefits of an insurance policy being assigned post-loss to predatory adjusters—has been a hot topic, particularly in those states where laws and regulations currently prevent insurance companies from being able to mitigate the problem.

What is assignment of benefits?

Typically, an insurance policy has a loss payment provision that advises the policyholder that any payment for a first-party loss will be paid directly to the insured unless another party is legally entitled to collect payment. However, a common practice by consumers after a loss is to have the contractor that will be making the repairs to the damaged property work directly with the insurance company for payment.

Some insurance providers have simplified this process by developing a network of trusted contractors that are allowed to inspect claims on their behalf. This creates a consumer-friendly environment where the insured, for the most part, is removed from the claims settlement process. However, consumers generally are free to make other choices, so if they decide on a contractor not in that network, the insurer most likely will work with the entity selected by the insured.

When a contractor, who is not in an insurance provider’s network, is chosen, the insured has two options: either receive payment from the insurance company and then work directly with the contractor or allow the contractor to work directly with the insurance company regarding repairs and payment. Insurance companies would likely prefer the first option because they can then more closely monitor the claims process. While the second option may be less desirable to the insurance company, certain states, like Florida, have laws in place that actually prevent the carrier from disallowing it.

What are the concerns with assignment of benefits?

Transferring the benefits of a policy to a third party, such as a contractor, does create a better customer experience; however, insurers generally lose a bit of control managing the claims process when working directly with the third party.

Several states (especially Florida as discussed below) have seen an influx in predatory public adjusters and contractors that seek out consumers who may potentially have a loss covered by their homeowners policy. These adjusters (that may also serve as the contractor making the repairs to the home) will have the consumer sign a transfer of benefits to them almost immediately after suffering the loss, and then they will work directly with the insurance company to complete the claims process.

One issue that arises (and often the consumer is unaware of this) is that the adjuster/contractor could be inflating the actual cost of the claim by reporting damage that may not actually have occurred. Additionally, the claim may not be reported to the insurance company until the repairs have already been completed so the insurance company has not had an opportunity to inspect the damage. Such tactics can result in additional profits for the adjuster/contractor, which translates to inflated severity and rising premiums for the consumer.

This issue may be particularly problematic in Florida, where insurance carriers may not be aware of potential losses until they’re served with a lawsuit for expenses incurred by the contractor that completed the repairs. In fact, the Florida Office of Insurance Regulation (FLOIR) released results from a study it conducted showing that the number of lawsuits attributed to assignment of benefits (AOB) increased from 408 in 2000 to more than 28,000 in 2016. Further, the average severity for claims where there is an AOB is about 85 percent more than those claims without an AOB.

How has this issue escalated?

Several factors have contributed to the growing problem of assignment of benefits in Florida; however, a combination of case law and legislation, which has made it difficult for insurance companies to mitigate claim costs and potential fraud, may be the most impactful.

In the 1917 landmark case of West Florida Grocery Co. v. Teutonia Fire Ins. Co., 77 So. 209, 210-, the state Supreme Court rendered a decision holding that the insured was able to assign the benefits of the policy following a loss directly to a third party without the written consent of the insurance provider. The precedent established by this 100-year-old case continues to make it very difficult for an insurance company to prohibit the assignment of benefits in Florida.

In addition to this case, Florida Statute §627.428 governing payment of attorneys’ fees related to insurance practices requires that insurance companies pay legal fees to third parties successfully suing to obtain payment for their services even if the ruling from the court places the amount of the claim only $1 above the insurance company’s offer in settlement. As a result, this statute incentivizes contractors to sue insurance companies for reimbursement, because the likelihood that they’ll have to pay their own legal fees for the case is very slim.

As reported by The Sun Sentinel earlier this year, consumers in southern Florida could expect to see rate increases averaging 5-15% as a result of claims abuse. Additionally, if it can be assumed that a significant number of the lawsuits complied in the FLOIR study referenced above were initiated by public adjusters and contractors seeking to be unjustly compensated, it could be suggested that this predatory behavior is factoring into these rate increases.

Despite this potential correlation, the legislature has yet to make changes to existing laws. While some members of Florida’s legislature favor the existing legislation, others are advocating for consumers and supporting legislation that would eliminate the abuse. Although remedial legislation did fail in 2017, some members have said they’re hopeful to get legislation passed in 2018.

How is ISO responding?

ISO has been reviewing policy language to determine the best course of action for responding to the growing crisis, especially in Florida. While prohibiting assignment of benefits post-loss altogether is not allowed by state law, several policy provisions can be modified to introduce parameters on how the benefits of the policy can be assigned to a third party. ISO is finalizing these changes and hopes to file in the first quarter of 2018 so that member companies can address this concern with or without any future changes to Florida law.

• Personal Property
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• Homeowners Underwriting

Cruising Altitude: What to know about getting bumped from a flight when airlines overbook

Welcome to Cruising Altitude, a new column at USA TODAY focusing on travel trends.

Many times when I fly I see people volunteering to give up their seat, and I totally get it. The lure of airline vouchers – or maybe even cash – is appealing, but alas, I am not so carefree. Even writing this out, the thought of tossing hypothetical plans to the wind is making me anxious. Let’s not even get to how I’d feel if I were the victim of “involuntary denied boarding.” Both scenarios can happen when airlines intentionally oversell flights and more people show up at the gate than there are seats on the plane, forcing them to keep some number of people grounded.

According to the Department of Transportation, voluntary and involuntary boarding denials (which, confusingly, are both referred to colloquially as “bumping”) were on the rise in 2022.

Part of that, surely, is explained by airlines just transporting more passengers last year than the year before, but the actual rate of bumping rose, even accounting for that. In 2021, airlines denied boarding on average to 0.17 of every 10,000 passengers booked to travel. In 2022, that stat was 0.32 denials per 10,000 passengers on average.

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Carriers asked people to voluntarily give up their seats more frequently in 2022, too, nearly doubling that number year over year.

Frontier Airlines had the most involuntary boarding denials in 2022, at a rate of 2.66 per 10,000 passengers, while Delta Air Lines got the most volunteers: more than 100,000 over the course of the year.

Glenn Nichols, a semi-retired hotelier in South Bend, Indiana, is one of those travelers who frequently put their hands up. He told me he makes it a point to arrange his travels so he can volunteer to get bumped whenever possible.

“I never regret it because it’s just something I kind of plan for,” he said. “It’s paid off for me.” 

Nichols said he once got $1,000 in airline credits for volunteering, but he has found compensation to be typically in the $500 to 800 range.

Involuntary versus voluntary denied boarding

Just to clarify: bumping can refer to an airline refusing you permission to get onto a flight, or to the auction scenario at the gate or in the app, when the carrier seeks the lowest bidder to give up their seat.

And yes, frustratingly to travelers, involuntary boarding denial is completely legal. Airlines are allowed to oversell flights – it’s actually a very common practice among U.S. carriers – and their contracts of carriage, which you essentially sign whenever you purchase a ticket, give them the right to refuse your seat.

In fact, during its most recent earnings call, Delta Air Lines announced it was planning to increase its overbooking rates in the coming quarters. While Delta had only two involuntary denied boardings in 2022, it will be interesting to see if the planned change affects that metric at all. Executives, for their part, assured those on the call that they’re not expecting any major uptick, and insisted that more overbooking will be good for the bottom line.

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Overbooking, however, isn’t the only reason an airline may have to keep people off their flight.

“My guess of what’s disrupting air travel right now is equipment changes,” Laurel Brunvoll, owner and president of the boutique luxury travel agency Unforgettable Trips , told me. She explained that airlines sometimes have to change the kind of aircraft operating a flight at the last minute, which can affect the number of seats available.

“There’s not enough room, so they’re just going to take people off,” she said.

Involuntary bumping remains fairly rare, though. Nearly 300,000 passengers like Nichols took offers to give up their seats in 2022, compared with less than 26,000 involuntary denials, according to the DOT.

What are you owed when you get bumped from a flight?

If you’re involuntarily denied boarding, the DOT actually has very specific rules about what you’re entitled to: 

• For domestic flights in the U.S., airlines have to pay you 200% of the value of your one-way ticket up to $775 if you arrive at your destination one to two hours past your originally scheduled itinerary or 400% of the one-way ticket price, up to $1,550 if your arrival delay is longer than two hours.
• For international flights departing the U.S., the 200% or $775 compensation window is up to four hours, with 400% up to $1,550 compensation owed for a delay of more than four hours.

Certain exceptions, including equipment changes, allow the airlines to avoid paying out this compensation. 

Brunvoll said she advises her clients to always take out travel insurance, which can help cover additional expenses like hotels and meals that an airline is not required to fully compensate you for if you do get bumped.

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Voluntary boarding denials involve some negotiation between the airline and its passengers, either at the gate or through the airline’s app, and compensation in those cases can often far exceed the DOT minimums. Some famous cases have landed willing passengers five-figure payments from their carriers. 

Brunvoll said it’s important to understand exactly what you’re getting before agreeing to give up your seat, however.

“Are you getting a voucher or are you getting money, and what else are you giving up?” she said. “You should also have it very clearly in writing what the plan of action is for you to get back on your track. Don’t just accept (a new itinerary) and then you find out it’s three days from today.” 

How can I avoid getting bumped from a flight?

First of all, keep in mind that it’s extremely unlikely you’ll get bumped. Not impossible, but unlikely.

Karen Hawes, a nurse practitioner in Manhattan, Kansas, said she has always careful to pay extra to select a seat as a hedge against bumping at her small hometown airport.

“I would tell people to pay the extra money, but complain about it,” Hawes said. “It’s a junk fee .”

She added that having a seat assignment before arriving at the airport has reliably meant she has never been bumped off any of the handful of flights that depart Manhattan every day, but she said it can feel like a bit of a scam.

“Really the issue is the threat of not being able to make our trips at all,” she said. “In rural areas, if you don’t get that flight, you’re just not going to go.” 

Other travel agents have told me that registering with an airline’s frequent flyer program and even having a paper boarding pass can help reduce your chances of getting bumped. 

Brunvoll also said it’s a good idea to book nonstop flights whenever possible because that reduces the odds of getting bumped. And no matter what happens, she said, remember to be nice.

“All of us need to try not to lose our cool at the airport.”

Zach Wichter is a travel reporter for USA TODAY based in New York. You can reach him at [email protected]

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