Understanding Unassigned Claim (Health Care): What You Need to Know

Q: Can a provider refuse to accept Medicare assignment?

Yes, providers can choose not to accept Medicare assignment, resulting in unassigned claims.

Q: How can I manage an unassigned claim?

Review your bill carefully, and consider using legal templates from US Legal Forms if you need to dispute charges or seek clarification.

Definition & Meaning

An unassigned claim in health care refers to a claim submitted for medical services or supplies provided by a physician or supplier who does not agree to accept Medicare's approved charge as full payment. When a provider accepts Medicare's approved amount, they are said to have accepted the assignment, and the claim is classified as an assigned claim. In contrast, unassigned claims occur when a provider opts not to accept Medicare's approved amount, meaning they charge the patient directly for the difference between their fees and what Medicare covers.

Table of content

Legal Use & context

Unassigned claims are primarily relevant in the context of Medicare and health care billing practices. This term is significant in civil law, particularly in health care law, where it affects how providers bill patients and how patients manage their medical expenses. Users can often handle unassigned claims through legal forms and templates available from US Legal Forms, which can help them navigate billing disputes or appeals related to these claims.

Key legal elements

Real-world examples

Here are a couple of examples of abatement:

Example 1: A patient visits a specialist who does not accept Medicare assignment. The specialist charges $200 for the visit, while Medicare only approves $100. The patient must pay the full $200, which includes the 20 percent coinsurance on the approved amount and the additional charge.

Example 2: A patient receives physical therapy from a provider who submits an unassigned claim. Medicare covers $80 of the $150 charge, leaving the patient responsible for the $70 difference. (hypothetical example)

State-by-state differences

State	Notes
California	Providers may charge up to 115% of the Medicare approved amount for unassigned claims.
New York	Patients are often responsible for the full amount charged by unassigned providers.
Texas	Providers must inform patients of their unassigned status before treatment.

This is not a complete list. State laws vary, and users should consult local rules for specific guidance.

Comparison with related terms

Term	Definition	Difference
Assigned Claim	A claim where the provider accepts Medicare's approved charge as full payment.	In an assigned claim, the provider agrees to accept the Medicare rate, unlike in an unassigned claim.
Medicare Assignment	The agreement by a provider to accept Medicare's approved amount as payment.	Assignment means the provider agrees to the Medicare fee schedule, while unassigned claims do not.

Common misunderstandings

What to do if this term applies to you

If you receive an unassigned claim, review the charges carefully. Understand that you may be responsible for paying the full amount charged by the provider. If you have questions about your bill or believe it is incorrect, consider contacting the provider for clarification. Additionally, you can explore US Legal Forms for templates that may assist you in managing disputes or appeals related to unassigned claims. If the situation becomes complex, seeking professional legal advice may be beneficial.

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Quick facts

Medicare pays 80 percent of the approved charge for assigned claims.
Patients may pay the full charge for services from providers who do not accept assignment.
Providers can charge up to 115 percent of Medicare's approved amount for unassigned claims.

Key takeaways

Frequently asked questions

What is the difference between assigned and unassigned claims?

Assigned claims are those where the provider accepts Medicare's approved amount as payment, while unassigned claims are billed directly to the patient for the full amount charged.