What is Assignment of Benefits?
“Assignment of Benefits” is a legally binding agreement between you and your Insurance Company, asking them to send your reimbursement checks directly to your doctor.
When our office accepts an assignment of benefits, this means that we have to wait for up to one month for your insurance reimbursement to arrive.
We accept assignment from our patients as a courtesy.
Assignment may be withdrawn if your Insurance Company practices certain
“Nuisance Behaviors” (see below).
There are several parts to your Health Insurance Policy
refers to the first portion of costs incurred during the insured year. For example, if you have a $200
deductible, this means that your Insurance Company expects you to pay for the first $200 of services that you receive in the given contract year.
After that, they will pay their portion, or Co-insurance, for care you receive during that year, or until you have received all the benefits that your policy provides.
refers to that percentage of cost which the Insurance Company expects you to pay. If your “co-insurance” is 80%, this means that the Insurance Company will pay 80% of what they consider “usual and customary” (or U&C), and they expect you to pay all the rest of the costs for any and all services provided.
refers to a specific charge you may have to pay for a particular service. The most-common co-pay is a flat fee for an initial exam or for re-exams. Not many policies include co-pays.
All reputable Insurance Companies utilize something called “Relative Value Units” (RVU) to determine the “usual and customary fee” (or U&C) that they are willing to pay.
The RV unit was developed to evaluate the time, complexity, and overhead costs associated with every service provided by your doctor.
The RV unit is a nationally accepted unit of value, which may be modified by a “locality percentage”. This explains why care in the Chicago region would cost more than in a smaller town that has lower overhead costs.
Some Insurance Companies create their own rate cards, paying providers fees that are far below what is commonly charged (RVU) by a profession for a particular service. That kind of Insurance Company falls into the “Nuisance Category”. If your Insurance Company ignores the nationally accepted RVU fee system, to reduce their overhead costs, they do so at YOUR expense, because that forces YOU to pay the difference.
Another nuisance activity is taking longer than 30 days to pay a claim. Illinois Insurance law directs Health Insurance companies to pay all claims within 30 days. Yet, some companies choose to take months to pay valid claims. If your insurance company practices these unfair and illegal tactics, we will help you file your claim, but we will NOT accept assignment of your benefits.
We will verify your Insurance coverage during your first week of care, but, there is no way for us to predict whether your company will “play fair” by using the RVU system. We cannot predict what they might pay for any particular service, because they do not hand out rate cards to providers. Only you, the policy holder, can have any impact on how they choose to behave, because of the legal and contractural relationship that exists between the two of you. Until we can verify your coverage, we will collect our full fee for any service(s) we provide.
We (may) agree to take on the extra expense of filing your claims as a consideration to you, but we have no contractual relationship with your Insurance Company (except for BCBS). Once your insurance company pays their portion for any date of service, you will be billed for any outstanding balance due. If they make any overpayments, we will cut you a check that day, to bring your balance back to zero.
If you have ANY issue with how your insurance company reimburses you or us for your care, or manages your claims in any fashion, it is YOUR responsibility to resolve those issues, directly with them.
If your neck or low back is “going out” more often than you are,|
you will definitely benefit from meeting “The Doc on The Block”
309 Bluff Avenue, # 1W
La Grange, IL 60525