Assignment of Benefits from Patients

New Jersey has recently enacted Legislation allowing Physicians and Medical Providers to obtain an Assignment of Benefits from patients to allow the Insurers to send payment for the medical services provided directly to the Medical Providers.  An Assignment of Benefits form must be provided to the Insurers through either a website portal or through fax or mail.  For information on the new Legislation requirements review this Dept. of Banking and Insurance notice.

 The Legislation provides that once the Assignment of Benefits form is provided if an insurer fails to pay the medical service provider directly and mistakenly sends payment to the patient the insurer is still liable to the medical service provider for payment. The Legislation known as NJSA 17B:30-59 provides:

17B:30-59. Assignment of benefits to service provider of right to receive reimbursement for ambulance service.

      a. Notwithstanding any provision of law to the contrary, a covered person may, through an assignment of benefits, assign to a service provider his right to receive reimbursement for any ambulance service rendered by the service provider, regardless of whether the service provider is under contract with the carrier to provide services to the covered person.

     b.     A service provider provided an assignment of benefits by a covered person, pursuant to subsection a. of this section, shall submit a copy of that assignment of benefits, or provide other notice of that assignment of benefits acceptable to the commissioner pursuant to regulation, to the payer with any claim for payment for any ambulance service rendered to the covered person.

     c.     The payer, based upon the claim and notice of the assignment of benefits submitted by the service provider, shall remit payment of the claim directly to the service provider within the timeframe established by P.L.1999, c.154 (C.17B:30-23 et al.) for remitting payment on a claim submitted by electronic means, or by other than electronic means, as applicable, and provide written notice, within the same applicable timeframe, of the payment to the covered person.

     d.     If a covered person executes an assignment of benefits, and the service provider submits notice of that assignment of benefits with its claim for payment pursuant to subsection b. of this section, but the payer remits payment of the claim to the covered person, rather than the service provider, the claim shall not be considered paid. The payer shall, notwithstanding the incorrect payment of the claim to the covered person, remain liable for remitting payment of the claim to the service provider pursuant to the assignment of benefits.

     e.     Any overdue payment on the claim to the service provider pursuant to the assignment of benefits shall accrue interest at the rate established by P.L.1999, c.154 (C.17B:30-23 et al.) for an overdue payment.

An Assignment of Benefits form is also necessary in order to pursue a PIP Arbitration through Forthright and must be provided with the initial demand for arbitration.  A sample form is provided below. 

ASSIGNMENT OF BENEFITS

I AUTHORIZE AND DIRECT MY INSURER OR PAYOR TO PAY DIRECTLY TO THE ABOVE[CENTER/PRACTICE], AND THE PHYSICIANS, ANY OR ALL BENEFITS, THAT WOULD OTHERWISE BE PAYABLE TO ME (OR THE PATIENT, IF SIGNED BY A RESPONSIBLE PARTY), UP TO THE AMOUNT OF MY BILL, ACCRUING TO ME IN CONNECTION WITH MY TREATMENT AT THE [CENTER/PRACTICE].

I REQUEST THAT PAYMENT OF AUTHORIZED MEDICARE, MEDIGAP OR OTHER HEALTH INSURANCE POLICY BENEFITS FOR SERVICES FURNISHED TO ME BY THE [CENTER/PRACTICE] BE MADE ON MY BEHALF TO THE [CENTER/PRACTICE]. IN THE EVENT THAT PAYMENTS ARE MADE TO THE [CENTER/PRACTICE] AND ME AS JOINT PAYEES, I AGREE TO COOPERATE WITH THE [CENTER/PRACTICE] TO ENSURE THAT THE CENTER/PRACTICE RECEIVES ALL AMOUNTS DUE TO THE [CENTER/PRACTICE].

I HEREBY AUTHORIZE THE [CENTER/PRACTICE] TO PURSUE ANY MEANS NECESSARY TO COLLECT ALL CHARGES ON MY ACCOUNT INCLUDING FOLLOW UP CALLS, APPEALS, ARBITRATION, AND CIVIL SUIT, IF ALLOWABLE UNDER LAW. IN THE EVENT THAT THE [CENTER/PRACTICE] OR PHYSICIAN ELECTS TO BRING AN APPEAL, LAWSUIT OR PETITION FOR ARBITRATION AGAINST THE INSURANCE CARRIER, I HEREBY ASSIGN TO THEM MY RIGHTS, TITLE, AND INTEREST UNDER ANY INSURANCE POLICY UNDER WHICH I AM ENTITLED TO PROCEED FOR BENEFITS, IF ALLOWABLE UNDER LAW. THIS ASSIGNMENT SHALL ALLOW AN ATTORNEY OF THEIR CHOOSING TO BRING SUIT OR SUBMIT TO ARBITRATION THEIR CLAIM OF ANY UNPAID OR UNDERPAID BILLS FOR TREATMENT RENDERED AT THE [CENTER/PRACTICE].

Dated:_______________________________

Patient