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What Is an Assignment of Benefits?

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  • Written By: Malcolm Tatum
  • Edited By: Bronwyn Harris
  • Last Modified Date: 12 August 2014
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    Conjecture Corporation
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An assignment of benefits is a that process makes it possible for payments from an insurance provider to be forwarded directly to the healthcare provider, rather than being sent directly to the insured party. This type of arrangement is common with many types of health insurance coverage, and often helps to simplify the process of paying for medical services in a timely manner. Many types of health coverage, including some government supported programs such as Medicare in the United States, allow for the assignment of benefits as a matter of course.

In order to establish an assignment of benefits, the insured party must usually sign some type of form or document that grants the physician or hospital the right to submit claims for services rendered directly to the patient’s insurance provider. The actual format of an assignment of benefits form will vary from one jurisdiction to another, depending on any laws or regulations that apply. Typically, the benefits form is a very simple instrument that simply states that the healthcare provider is providing medical care of some type to the patient, and the patient wishes the insurance company to forward all payments on covered services directly to that provider.

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One of the main advantages of an assignment of benefits for the insured party is the ability to avoid spending time filling out and submitting claims for healthcare services rendered. In most cases, a doctor, hospital, or other healthcare facility will manage the submission of claims on behalf of the patient. Those claims are prepared in accordance with the standards of the insurance provider, including all data relevant to the services rendered. Assuming that the course of treatment is covered by the terms and provisions of the insurance, the provider approves the payment, less any deductibles or other restrictions that may apply, and remits that payment to the claim sender and not to the patient.

In order for the assignment of benefits to apply, the medical services provided must be covered in the provisions of the insurance policy. For example, if a health insurance plan does not include a dental rider, the issuer of the plan will not forward any payments to the dentist, even if the patient signed an assignment of benefits form. It is not unusual for healthcare providers to request information regarding the policy coverage in advance, making it possible to ascertain if the treatments are insured under the terms of the plan. If not, then the healthcare provider will often seek to make alternative payment arrangements with the patient prior to the initiation of those treatments.

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