How does assignment of benefits interact with provider billing?

• A. The insured pays all costs upfront and files a reimbursement claim.
• B. The provider can bill the insurer directly; the insured's responsibility is to pay any remaining balance such as deductible or coinsurance.
• C. The insurer pays the full amount regardless of bills.
• D. The provider cannot bill the insurer directly.

Answer: (B)

Assignment of benefits means the patient signs over the right to receive payment for covered services to the provider. With this arrangement, the provider can bill the insurer directly for services, and the insured is responsible only for any remaining amount such as the deductible or coinsurance, plus any noncovered charges. This setup simplifies payment and often reduces or eliminates the need for the patient to pay the full bill upfront and seek reimbursement later.

In other words, the insurer’s payment goes straight to the provider, and the patient’s out-of-pocket costs are limited to the plan-defined deductible, coinsurance, and any noncovered services.