“When a patient offers their right to obtain benefits from their insurance, that assignment of benefits is in and of itself consideration in full, exchanged for services and treatment. An assignment of benefits is thus not a form of access to consideration, and rather, is the consideration itself. One might ask why a medical service provider would ever choose to accept an assignment of benefits in lieu of the right to bill a patient for 100%. ” – Adam Russo, Attorney
TO: All Full-Time Employees Lucky Enough To Work Here
FROM: Your Loving HR Department
Your health plan is a Company Medical Expense Account funded in return for lower wages. We guess you probably didn’t realize that but it’s true, it really is your money paying for all of this. We thank you for that!
We hope you will begin to treat your Medical Expense Account as if it is your money to be spent wisely and efficiently, not other people’s money to be spent recklessly with abandon. The rewards can be significant.
When seeking medical services it’s important to present your Company Medical Expense Account identification card. The information on the back of the card will be of utmost importance to your provider:
This is a non-traditional health plan. The plan does not use a network. Medical providers are paid based on current Medicare reimbursement rates. There is no member cost sharing. The No Surprises Act (NSA) / Independent Dispute Resolution (IDR) does not apply to this plan. Providers accepting Assignment of Benefits agree to the terms and conditions of the Plan Document as consideration in full and agrees to be limited by the same terms and provisions as the plan member from whom the assignment is received.
In the absence of an Assignment of Benefits, your company medical expense account reimbursement will be made to you. You may apply the amount to what you agree to pay and to which the provider accepts or you may pay for that luxury trip to Tahiti you’ve always dreamed about. It’s your choice.
Choice is good.
The later is no different than auto insurance. Your vehicle is involved in an accident and seeks treatment from Dr. Body Shop. An adjuster determines the value of the work to be performed and issues the check to you. You bargain with Dr. Shop who agrees to accept less than what your auto insurance has paid you. You pocket the difference and buy that bass boat you’ve always wanted.
P.S. – Don’t forget the wife, sharing is caring!