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What does it mean if your doctor doesn’t accept assignment?

  • January 16, 2015

Q: What does it mean if your doctor doesn’t accept assignment?

A: If your doctor doesn’t “accept assignment,” it means he or she might see Medicare patients but wants to be paid his or her full fee – not just the amount that Medicare is willing to pay. As a result, you may end up paying the difference between what Medicare will pay and what your provider charges – up to 15 percent above the amount that non-participating providers are paid by Medicare.

If your doctor doesn’t accept assignment, you may have to pay the entire bill up front and seek reimbursement for the portion that Medicare will pay.

Participating Medicare providers are those who have agreed to accept Medicare’s negotiated payments as payment in full for all Medicare services.

Non-participating providers are those who haven’t agreed to to that requirement for all Medicare services, but who are willing to accept assignment for some individual services. (If they accept assignment, they can’t bill the patient for any additional amounts beyond the regular Medicare copays and coinsurance, for that specific treatment.)

Providers who don’t accept assignment have no contract at all with Medicare, leaving patients with potential exposure to higher out-of-pocket costs.