Author Topic: Accepting Assignment on Out of Network Claims - Can you balance bill the patient  (Read 2768 times)

mpisaniello

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If you file a Out of Network claim and "Accept Assignment" in block 27 of the CMS 1500 claim form to a non medicare insurance company are we accepting payment in full or can we balance bill ( up to bill charges ) the patient?

1.  If patient has Out of network benefits

2.  If patient does not have out of network benefits?

Does anyone know where the documentation to this issue can be found?

James B

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We are OON for all ins. except Medicare and accept assignment from the others, and YES we balance bill patients. If patient has no OON I have no choice but to treat them like self pay. If patient has OON, we either: a) charge a copay, similar to an in-network provider b) balance bill for whatever insurance doesn't pay or c) in some cases we'll simply accept whatever the patient's insurance pays. Hope that helps.

James

Michele

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Each insurance carrier will have their own rules on this but I believe in some cases if you "accept assignment" in box 27 that you may be agreeing to accept their fee allowance as well so I would recommend checking with each carrier.
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