what is accept assignment for insurance

As a Medical Biller, the better you understand the medical insurance payment process, the better you can care for your patients. Your understanding of what a patient will owe and what will be covered can help them navigate the confusing world of medical insurance.

One term that can be very confusing for patients (and for doctors as well) is ‘Accepting Assignment’.

Essentially, ‘assignment’ means that a doctor, (also known as provider or supplier) agrees (or is required by law) to accept a Medicare-approved amount as full payment for covered services.

This amount may be lower or higher than an individual’s insurance amount, but will be on par with Medicare fees for the services.

If a doctor participates with an insurance carrier, they have a contract and agree that the provider will accept the allowed amount, then the provider would check “yes”.  

If they do not participate and do not wish to accept what the insurance carrier allows, they would check “no”.   It is important to note that a provider who does not participate can still opt to accept assignment on just a particular claim by checking the “yes” box just for those services.

In other words by saying your office will accept assignment, you are agreeing to the payment amount being covered by the insurer, or medicare, and the patient has no responsibility.

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Find-A-Code Articles, Published 2014, August 1

What does accept assignment mean.

by   InstaCode Institute Aug 1st, 2014 - Reviewed/Updated Mar 5th

What does it mean to accept assignment on the CMS 1500 claim form - also called the HCFA 1500 claim form.? Should I accept assignment or not? What are the guidelines for accepting assignment in box 27 of the 1500 claim?

These commonly asked questions should have a simple answer, but the number of court cases indicates that it is not as clear cut as it should be. This issue is documented in the book “Problems in Health Care Law” by Robert Desle Miller. The definition appears to be in the hands of the courts. However, we do have some helpful guidelines for you.

One major area of confusion is the relationship between box 12, box 13 and box 27.  These are not interchangeable boxes and they are not necessarily related to each other.

According to the National Uniform Claim Committee (NUCC), the "Accept Assignment" box indicates that the provider agrees to accept assignment.  It simply says to enter an X in the correct box.  It does NOT define what accepting assignment might or might not mean.

It is important to understand that if you are a participating provider in any insurance plan or program, you must first follow the rules according to the contract that you sign. That contract supersedes any guidelines that are included here.

Medicare Instructions / Guidelines

PARTICIPATING providers MUST accept assignment according to the terms of their contract.  The contract itself states:

“Meaning of  Assignment  - For purposes of this agreement, accepting  assignment  of the Medicare Part B payment means requesting direct Part B payment from the Medicare program.  Under an  assignment , the approved charge, determined by the Medicare carrier, shall be the full charge for the service covered under Part B.  The participant shall not collect from the beneficiary or other person or organization for covered services more than the applicable deductible and coinsurance.”

By law, the providers or types of services listed below MUST also accept assignment:

• Clinical diagnostic laboratory services;
• Physician services to individuals dually entitled to Medicare and Medicaid;
• Services of physician assistants, nurse practitioners, clinical nurse specialists, nurse midwives, certified registered nurse anesthetists, clinical psychologists, and clinical social workers;
• Ambulatory surgical center services for covered ASC procedures;
• Home dialysis supplies and equipment paid under Method II;
• Ambulance services;
• Drugs and biologicals; and
• Simplified Billing Roster for influenza virus vaccine and pneumococcal vaccine.

NON-PARTICIPATING providers can choose whether to accept assignment or not, unless they or the service they are providing is on the list above.

The official Medicare instructions regarding Boxes 12 and 13 are:

“Item 12 – The patient's signature authorizes release of medical information necessary to process the claim. It  also authorizes payments of benefits  to the provider of service or supplier when the provider of service or supplier accepts assignment on the claim.” “Item 13 - The patient’s signature or the statement “signature on file” in this item  authorizes payment of medical benefits  to the physician or supplier. The patient or his/her authorized representative signs this item or the signature must be on file separately with the provider as an authorization. However, note that when payment under the Act can only be made on an assignment-related basis or when payment is for services furnished by a participating physician or supplier, a patient’s signature or a “signature on file” is not required in order for Medicare payment to be made directly to the physician or supplier.”

Regardless of the wording on these instructions stating that it authorizes payments to the physician, this is not enough to ensure that payment will come directly to you instead of the patient.To guarantee payment comes to you, you MUST accept assignment.

Under Medicare rules, PARTICIPATING providers are paid at 80% of the  physician fee schedule allowed amount  and NON-participating providers are paid at 80% of the allowed amount, which is 5% less than the full Allowed amount for participating providers. Only NON-participating providers may "balance bill" the patient for any amounts not paid by Medicare, however, they are subject to any state laws regarding balance billing.

TIP: If you select YES, you may or may not be subject to a lower fee schedule, but at least you know the payment is  supposed  to come to you.

NON-MEDICARE Instructions / Guidelines

PARTICIPATING providers MUST abide by the terms of their contract.  In most cases, this includes the requirement to accept assignment on submitted claims.

NON-PARTICIPATING providers have the choice to accept or not accept assignment.

YES means that payment should go directly to you instead of the patient.  Generally speaking, even if you have an assignment of benefits from the patient (see box 12 & 13), payment is ONLY guaranteed to go to you IF you accept assignment.

NO is appropriate for patients who have paid for their services in full so they may be reimbursed by their insurance.  It generally means payment will go to the patient.

What Does Accept Assignment Mean?. (2014, August 1). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/what-does-accept-assignment-mean-34840.html

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Medicare Assignment

Home / Medicare 101 / Medicare Costs / Medicare Assignment

Summary: If a provider accepts Medicare assignment, they accept the Medicare-approved amount for a covered service. Though most providers accept assignment, not all do. In this article, we’ll explain the differences between participating, non-participating, and opt-out providers. You’ll also learn how to find physicians in your area who accept Medicare assignment. Estimated Read Time: 5 min

What is Medicare Assignment

Medicare assignment is an agreement by your doctor or other healthcare providers to accept the Medicare-approved amount as the full cost for a covered service. Providers who “accept assignment” bill Medicare directly for Part B-covered services and cannot charge you more than the applicable deductible and coinsurance.

Most healthcare providers who opt-in to Medicare accept assignment. In fact, CMS reported in its Medicare Participation for Calendar Year 2024 announcement that 98 percent of Medicare providers accepted assignment in 2023.

Providers who accept Medicare are divided into two groups: Participating providers and non-participating providers. Providers can decide annually whether they want to participate in Medicare assignment, or if they want to be non-participating.

Providers who do not accept Medicare Assignment can charge up to 15% above the Medicare-approved cost for a service. If this is the case, you will be responsible for the entire amount (up to 15%) above what Medicare covers.

Below, we’ll take a closer look at participating, non-participating, and opt-out physicians.

Medicare Participating Providers: Providers Who Accept Medicare Assignment

Healthcare providers who accept Medicare assignment are known as “participating providers”. To participate in Medicare assignment, a provider must enter an agreement with Medicare called the Participating Physician or Supplier Agreement. When a provider signs this agreement, they agree to accept the Medicare-approved charge as the full charge of the service. They cannot charge the beneficiary more than the applicable deductible and coinsurance for covered services.

Each year, providers can decide whether they want to be a participating or non-participating provider. Participating in Medicare assignment is not only beneficial to patients, but to providers as well. Participating providers get paid by Medicare directly, and when a participating provider bills Medicare, Medicare will automatically forward the claim information to Medicare Supplement insurers. This makes the billing process much easier on the provider’s end.

Medicare Non-Participating Providers: Providers Who Don’t Accept Assignment

Healthcare providers who are “non-participating” providers do not agree to accept assignment and can charge up to 15% over the Medicare-approved amount for a service. Non-participating Medicare providers still accept Medicare patients. However they have not agreed to accept the Medicare-approved cost as the full cost for their service.

Doctors who do not sign an assignment agreement with Medicare can still choose to accept assignment on a case-by-case basis. When non-participating providers do add on excess charges , they cannot charge more than 15% over the Medicare-approved amount. It’s worth noting that providers do not have to charge the maximum 15%; they may only charge 5% or 10% over the Medicare-approved amount.

When you receive a Medicare-covered service at a non-participating provider, you may need to pay the full amount at the time of your service; a claim will need to be submitted to Medicare for you to be reimbursed. Prior to receiving care, your provider should give you an Advanced Beneficiary Notice (ABN) to read and sign. This notice will detail the services you are receiving and their costs.

Non-participating providers should include a CMS-approved unassigned claim statement in the additional information section of your Advanced Beneficiary Notice. This statement will read:

“This supplier doesn’t accept payment from Medicare for the item(s) listed in the table above. If I checked Option 1 above, I am responsible for paying the supplier’s charge for the item(s) directly to the supplier. If Medicare does pay, Medicare will pay me the Medicare-approved amount for the item(s), and this payment to me may be less than the supplier’s charge.”

This statement basically summarizes how excess charges work: Medicare will pay the Medicare-approved amount, but you may end up paying more than that.

Your provider should submit a claim to Medicare for any covered services, however, if they refuse to submit a claim, you can do so yourself by using CMS form 1490S .

Opt-Out Providers: What You Need to Know

Opt-out providers are different than non-participating providers because they completely opt out of Medicare. What does this mean for you? If you receive supplies or services from a provider who opted out of Medicare, Medicare will not pay for any of it (except for emergencies).

Physicians who opt-out of Medicare are even harder to find than non-participating providers. According to a report by KFF.org, only 1.1% of physicians opted out of Medicare in 2023. Of those who opted out, most are physicians in specialty fields such as psychiatry, plastic and reconstructive surgery, and neurology.

How to Find A Doctor Who Accepts Medicare Assignment

Finding a doctor who accepts Medicare patients and accepts Medicare assignment is generally easier than finding a provider who doesn’t accept assignment. As we mentioned above, of all the providers who accept Medicare patients, 98 percent accept assignment.

The easiest way to find a doctor or healthcare provider who accepts Medicare assignment is by visiting Medicare.gov and using their Compare Care Near You tool . When you search for providers in your area, the Care Compare tool will let you know whether a provider is a participating or non-participating provider.

If a provider is part of a group practice that involves multiple providers, then all providers in that group must have the same participation status. As an example, we have three doctors, Dr. Smith, Dr. Jones, and Dr. Shoemaker, who are all part of a group practice called “Health Care LLC”. The group decides to accept Medicare assignment and become a participating provider. Dr. Smith decides he does not want to accept assignment, however, because he is part of the “Health Care LLC” group, he must remain a participating provider.

Using Medicare’s Care Compare tool, you can select a group practice and see their participation status. You can then view all providers who are part of that group. This makes finding doctors who accept assignment even easier.

To ensure you don’t end up paying more out-of-pocket costs than you anticipated, it’s always a good idea to check with your provider if they are a participating Medicare provider. If you have questions regarding Medicare assignment or are having trouble determining whether a provider is a participating provider, you can contact Medicare directly at 1-800-633-4227. If you have questions about excess charges or other Medicare costs and would like to speak with a licensed insurance agent, you can contact us at the number above.

Announcement About Medicare Participation for Calendar Year 2024, Centers for Medicare & Medicaid Services. Accessed January 2024

https://www.cms.gov/files/document/medicare-participation-announcement.pdf

Annual Medicare Participation Announcement, CMS.gov. Accessed January 2024

https://www.cms.gov/medicare-participation

Does Your Provider Accept Medicare as Full Payment? Medicare.gov. Accessed January 2024

https://www.medicare.gov/basics/costs/medicare-costs/provider-accept-Medicare

Thomas Liquori

Ashlee Zareczny

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Does your provider accept Medicare as full payment?

You can get the lowest cost if your doctor or other health care provider accepts the Medicare-approved amount  as full payment for a covered service. This is called “accepting assignment.” If a provider accepts assignment, it’s for all Medicare-covered Part A and Part B services.

Using a provider that accepts assignment

Most doctors, providers, and suppliers accept assignment, but always check to make sure that yours do.

If your doctor, provider, or supplier accepts assignment:

• Your out-of-pocket costs may be less.
• They agree to charge you only the Medicare deductible and coinsurance amount, and usually wait for Medicare to pay its share before asking you to pay your share.
• They have to submit your claim directly to Medicare and can't charge you for submitting the claim.

How does assignment impact my drug coverage?

Using a provider that doesn't accept Medicare as full payment

Some providers who don’t accept assignment still choose to accept the Medicare-approved amount for services on a case-by-case basis. These providers are called "non-participating."

If your doctor, provider, or supplier doesn't accept assignment:

• You might have to pay the full amount at the time of service.
• They should submit a claim to Medicare for any Medicare-covered services they give you, and they can’t charge you for submitting a claim. If they refuse to submit a Medicare claim, you can submit your own claim to Medicare. Get the Medicare claim form .
• They can charge up to 15% over the Medicare-approved amount for a service, but no more than that. This is called "the limiting charge."  

Does the limiting charge apply to all Medicare-covered services?

Using a provider that "opts-out" of Medicare

• Doctors and other providers who don’t want to work with the Medicare program may "opt out" of Medicare.
• Medicare won’t pay for items or services you get from provider that opts out, except in emergencies.
• Providers opt out for a minimum of 2 years. Every 2 years, the provider can choose to keep their opt-out status, accept Medicare-approved amounts on a case-by-case basis ("non-participating"), or accept assignment.

Find providers that opted out of Medicare.

Private contracts with doctors or providers who opt out

• If you choose to get services from an opt-out doctor or provider you may need to pay upfront, or set up a payment plan with the provider through a private contract.
• Medicare won’t pay for any service you get from this doctor, even if it’s a Medicare-covered service.

What are the rules for private contracts?

You may want to contact your  State Health Insurance Assistance Program (SHIP) for help before signing a private contract with any doctor or other health care provider.

What do you want to do next?

• Next step: Get help with costs
• Take action: Find a provider
• Get details: How to get Medicare services

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Balance Billing in Health Insurance

• How It Works
• When It Happens
• What to Do If You Get a Bill
• If You Know in Advance

Balance billing happens after you’ve paid your deductible , coinsurance or copayment and your insurance company has also paid everything it’s obligated to pay toward your medical bill. If there is still a balance owed on that bill and the healthcare provider or hospital expects you to pay that balance, you’re being balance billed.

This article will explain how balance billing works, and the rules designed to protect consumers from some instances of balance billing.

Is Balance Billing Legal or Not?

Sometimes it’s legal, and sometimes it isn’t; it depends on the circumstances.

Balance billing is generally illegal :

• When you have Medicare and you’re using a healthcare provider that accepts Medicare assignment .
• When you have Medicaid and your healthcare provider has an agreement with Medicaid.
• When your healthcare provider or hospital has a contract with your health plan and is billing you more than that contract allows.
• In emergencies (with the exception of ground ambulance charges), or situations in which you go to an in-network hospital but unknowingly receive services from an out-of-network provider.

In the first three cases, the agreement between the healthcare provider and Medicare, Medicaid, or your insurance company includes a clause that prohibits balance billing.

For example, when a hospital signs up with Medicare to see Medicare patients, it must agree to accept the Medicare negotiated rate, including your deductible and/or coinsurance payment, as payment in full. This is called accepting Medicare assignment .

And for the fourth case, the No Surprises Act , which took effect in 2022, protects you from "surprise" balance billing.

Balance billing is usually legal :

• When you choose to use a healthcare provider that doesn’t have a relationship or contract with your insurer (including ground ambulance charges, even after implementation of the No Surprises Act).
• When you’re getting services that aren’t covered by your health insurance policy, even if you’re getting those services from a provider that has a contract with your health plan.

The first case (a provider not having an insurer relationship) is common if you choose to seek care outside of your health insurance plan's network.

Depending on how your plan is structured, it may cover some out-of-network costs on your behalf. But the out-of-network provider is not obligated to accept your insurer's payment as payment in full. They can send you a bill for the remainder of the charges, even if it's more than your plan's out-of-network copay or deductible.

(Some health plans, particularly HMOs and EPOs , simply don't cover non-emergency out-of-network services at all, which means they would not cover even a portion of the bill if you choose to go outside the plan's network.)

Getting services that are not covered is a situation that may arise, for example, if you obtain cosmetic procedures that aren’t considered medically necessary, or fill a prescription for a drug that isn't on your health plan's formulary . You’ll be responsible for the entire bill, and your insurer will not require the medical provider to write off any portion of the bill—the claim would simply be rejected.

Prior to 2022, it was common for people to be balance billed in emergencies or by out-of-network providers that worked at in-network hospitals. In some states, state laws protected people from these types of surprise balance billing if they had state-regulated health plans.

But not all states had these protections. And the majority of people with employer-sponsored health insurance are covered under self-insured plans, which are not subject to state regulations. This is why the No Surprises Act was so necessary.

How Balance Billing Works

When you get care from a doctor, hospital, or other healthcare provider that isn’t part of your insurer’s provider network  (or, if you have Medicare, from a provider that has opted out of Medicare altogether , which is rare but does apply in some cases ), that healthcare provider can charge you whatever they want to charge you (with the exception of emergencies or situations where you receive services from an out-of-network provider while you're at an in-network hospital).

Since your insurance company hasn’t negotiated any rates with that provider, they aren't bound by a contract with your health plan.

Medicare Limiting Charge

If you have Medicare and your healthcare provider is a nonparticipating provider but hasn't entirely opted out of Medicare, you can be charged up to 15% more than the allowable Medicare amount for the service you receive (some states impose a lower limit).

This 15% cap is known as the limiting charge, and it serves as a restriction on balance billing in some cases. If your healthcare provider has opted out of Medicare entirely, they cannot bill Medicare at all and you'll be responsible for the full cost of your visit.

If your health insurance company agrees to pay a percentage of your out-of-network care, the health plan doesn’t pay a percentage of what’s actually billed . Instead, it pays a percentage of what it says should have been billed, otherwise known as a reasonable and customary amount.

As you might guess, the reasonable and customary amount is usually lower than the amount you’re actually billed. The balance bill comes from the gap between what your insurer says is reasonable and customary, and what the healthcare provider or hospital actually charges.

Let's take a look at an example in which a person's health plan has 20% coinsurance for in-network hospitalization and 40% coinsurance for out-of-network hospitalization. And we're going to assume that the No Surprises Act does not apply (ie, that the person chooses to go to an out-of-network hospital, and it's not an emergency situation).

In this scenario, we'll assume that the person already met their $1,000 in-network deductible and $2,000 out-of-network deductible earlier in the year (so the example is only looking at coinsurance).

And we'll also assume that the health plan has a $6,000 maximum out-of-pocket for in-network care, but no cap on out-of-pocket costs for out-of-network care:

When Does Balance Billing Happen?

In the United States, balance billing usually happens when you get care from a healthcare provider or hospital that isn’t part of your health insurance company’s provider network or doesn’t accept Medicare or Medicaid rates as payment in full.

If you have Medicare and your healthcare provider has opted out of Medicare entirely, you're responsible for paying the entire bill yourself. But if your healthcare provider hasn't opted out but just doesn't accept assignment with Medicare (ie, doesn't accept the amount Medicare pays as payment in full), you could be balance billed up to 15% more than Medicare's allowable charge, in addition to your regular deductible and/or coinsurance payment.

Surprise Balance Billing

Receiving care from an out-of-network provider can happen unexpectedly, even when you try to stay in-network. This can happen in emergency situations—when you may simply have no say in where you're treated or no time to get to an in-network facility—or when you're treated by out-of-network providers who work at in-network facilities.

For example, you go to an in-network hospital, but the radiologist who reads your X-rays isn’t in-network. The bill from the hospital reflects the in-network rate and isn't subject to balance billing, but the radiologist doesn’t have a contract with your insurer, so they can charge you whatever they want. And prior to 2022, they were allowed to send you a balance bill unless state law prohibited it.

Similar situations could arise with:

• Anesthesiologists
• Pathologists (laboratory doctors)
• Neonatologists (doctors for newborns)
• Intensivists (doctors who specialize in ICU patients)
• Hospitalists (doctors who specialize in hospitalized patients)
• Radiologists (doctors who interpret X-rays and scans)
• Ambulance services to get you to the hospital, especially air ambulance services, where balance billing was frighteningly common
• Durable medical equipment suppliers (companies that provide the crutches, braces, wheelchairs, etc. that people need after a medical procedure)

These "surprise" balance billing situations were particularly infuriating for patients, who tended to believe that as long as they had selected an in-network medical facility, all of their care would be covered under the in-network terms of their health plan.

To address this situation, many states enacted consumer protection rules that limited surprise balance billing prior to 2022. But as noted above, these state rules don't protect people with self-insured employer-sponsored health plans, which cover the majority of people who have employer-sponsored coverage.

There had long been broad bipartisan support for the idea that patients shouldn't have to pay additional, unexpected charges just because they needed emergency care or inadvertently received care from a provider outside their network, despite the fact that they had purposely chosen an in-network medical facility. There was disagreement, however, in terms of how these situations should be handled—should the insurer have to pay more, or should the out-of-network provider have to accept lower payments? This disagreement derailed numerous attempts at federal legislation to address surprise balance billing.

But the Consolidated Appropriations Act, 2021, which was enacted in December 2020, included broad provisions (known as the No Surprises Act) to protect consumers from surprise balance billing as of 2022. The law applies to both self-insured and fully-insured plans, including grandfathered plans, employer-sponsored plans, and individual market plans.

It protects consumers from surprise balance billing charges in nearly all emergency situations and situations when out-of-network providers offer services at in-network facilities, but there's a notable exception for ground ambulance charges.

This is still a concern, as ground ambulances are among the medical providers most likely to balance bill patients and least likely to be in-network, and patients typically have no say in what ambulance provider comes to their rescue in an emergency situation. But other than ground ambulances, patients are no longer subject to surprise balance bills as of 2022.

The No Surprises Act did call for the creation of a committee to study ground ambulance charges and make recommendations for future legislation to protect consumers. The Biden Administration announced the members of that committee in late 2022, and the committee began holding meetings in May 2023.

Balance billing continues to be allowed in other situations (for example, the patient simply chooses to use an out-of-network provider). Balance billing can also still occur when you’re using an in-network provider, but you’re getting a service that isn’t covered by your health insurance. Since an insurer doesn’t negotiate rates for services it doesn’t cover, you’re not protected by that insurer-negotiated discount. The provider can charge whatever they want, and you’re responsible for the entire bill.

It is important to note that while the No Surprises Act prohibits balance bills from out-of-network working at in-network facilities, the final rule for implementation of the law defines facilities as "hospitals, hospital outpatient departments, critical access hospitals, and ambulatory surgical centers." Other medical facilities are not covered by the consumer protections in the No Surprises Act.

Balance billing doesn’t usually happen with in-network providers or providers that accept Medicare assignment . That's because if they balance bill you, they’re violating the terms of their contract with your insurer or Medicare. They could lose the contract, face fines, suffer severe penalties, and even face criminal charges in some cases.

If You Get an Unexpected Balance Bill

Receiving a balance bill is a stressful experience, especially if you weren't expecting it. You've already paid your deductible and coinsurance and then you receive a substantial additional bill—what do you do next?

First, you'll want to try to figure out whether the balance bill is legal or not. If the medical provider is in-network with your insurance company, or you have Medicare or Medicaid and your provider accepts that coverage, it's possible that the balance bill was a mistake (or, in rare cases, outright fraud).

And if your situation is covered under the No Surprises Act (ie, an emergency, or an out-of-network provider who treated you at an in-network facility), you should not be subject to a balance bill. So be sure you understand what charges you're actually responsible for before paying any medical bills.

If you think that the balance bill was an error, contact the medical provider's billing office and ask questions. Keep a record of what they tell you so that you can appeal to your state's insurance department if necessary.

If the medical provider's office clarifies that the balance bill was not an error and that you do indeed owe the money, consider the situation—did you make a mistake and select an out-of-network healthcare provider? Or was the service not covered by your health plan?

If you went to an in-network facility for a non-emergency, did you waive your rights under the No Surprises Act (NSA) and then receive a balance bill from an out-of-network provider? This is still possible in limited circumstances, but you would have had to sign a document indicating that you had waived your NSA protections.

Negotiate With the Medical Office

If you've received a legitimate balance bill, you can ask the medical office to cut you some slack. They may be willing to agree to a payment plan and not send your bill to collections as long as you continue to make payments.

Or they may be willing to reduce your total bill if you agree to pay a certain amount upfront. Be respectful and polite, but explain that the bill caught you off guard. And if it's causing you significant financial hardship, explain that too.

The healthcare provider's office would rather receive at least a portion of the billed amount rather than having to wait while the bill is sent to collections. So the sooner you reach out to them, the better.

Negotiate With Your Insurance Company

You can also negotiate with your insurer. If your insurer has already paid the out-of-network rate on the reasonable and customary charge, you’ll have difficulty filing a formal appeal since the insurer  didn’t actually deny your claim . It paid your claim, but at the out-of-network rate.

Instead, request a reconsideration. You want your insurance company to  reconsider the decision to cover this as out-of-network care , and instead cover it as in-network care. You’ll have more luck with this approach if you had a compelling medical or logistical reason for choosing an out-of-network provider .

If you feel like you’ve been treated unfairly by your insurance company, follow your health plan’s internal complaint resolution process.

You can get information about your insurer’s complaint resolution process in your benefits handbook or from your human resources department. If this doesn’t resolve the problem, you can complain to your state’s insurance department.

• Learn more about your internal and external appeal rights.
• Find contact information for your Department of Insurance using this resource .

If your health plan is self-funded , meaning your employer is the entity actually paying the medical bills even though an insurance company may administer the plan, then your health plan won't fall under the jurisdiction of your state’s department of insurance.

Self-funded plans are instead regulated by the Department of Labor’s Employee Benefit Services Administration. Get more information from the  EBSA’s consumer assistance web page  or by calling an EBSA benefits advisor at 1-866-444-3272.

If You Know You’ll Be Legally Balance Billed

If you know in advance that you’ll be using an out-of-network provider or a provider that doesn’t accept Medicare assignment, you have some options. However, none of them are easy and all require some negotiating.

Ask for an estimate of the provider’s charges. Next, ask your insurer what they consider the reasonable and customary charge for this service to be. Getting an answer to this might be tough, but be persistent.

Once you have estimates of what your provider will charge and what your insurance company will pay, you’ll know how far apart the numbers are and what your financial risk is. With this information, you can narrow the gap. There are only two ways to do this: Get your provider to charge less or get your insurer to pay more.

Ask the provider if he or she will accept your insurance company’s reasonable and customary rate as payment in full. If so, get the agreement in writing, including a no-balance-billing clause.

If your provider won’t accept the reasonable and customary rate as payment in full, start working on your insurer. Ask your insurer to increase the amount they’re calling reasonable and customary for this particular case.

Present a convincing argument by pointing out why your case is more complicated, difficult, or time-consuming to treat than the average case the insurer bases its reasonable and customary charge on.

Single-Case Contract

Another option is to ask your insurer to negotiate a  single-case contract   with your out-of-network provider for this specific service.

A single-case contract is more likely to be approved if the provider is offering specialized services that aren't available from locally-available in-network providers, or if the provider can make a case to the insurer that the services they're providing will end up being less expensive in the long-run for the insurance company.

Sometimes they can agree upon a single-case contract for the amount your insurer usually pays its in-network providers. Sometimes they’ll agree on a single-case contract at the discount rate your healthcare provider accepts from the insurance companies she’s already in-network with.

Or, sometimes they can agree on a single-case contract for a percentage of the provider’s billed charges. Whatever the agreement, make sure it includes a no-balance-billing clause.

Ask for the In-Network Coinsurance Rate

If all of these options fail, you can ask your insurer to cover this out-of-network care using your in-network coinsurance rate. While this won’t prevent balance billing, at least your insurer will be paying a higher percentage of the bill since your coinsurance for in-network care is lower than for out-of-network care.

If you pursue this option, have a convincing argument as to why the insurer should treat this as in-network. For example, there are no local in-network surgeons experienced in your particular surgical procedure, or the complication rates of the in-network surgeons are significantly higher than those of your out-of-network surgeon.

Balance billing refers to the additional bill that an out-of-network medical provider can send to a patient, in addition to the person's normal cost-sharing and the payments (if any) made by their health plan. The No Surprises Act provides broad consumer protections against "surprise" balance billing as of 2022.

A Word From Verywell

Try to prevent balance billing by staying in-network, making sure your insurance company covers  the services you’re getting, and complying with any pre-authorization requirements. But rest assured that the No Surprises Act provides broad protections against surprise balance billing.

This means you won't be subject to balance bills in emergencies (except for ground ambulance charges, which can still generate surprise balance bills) or in situations where you go to an in-network hospital but unknowingly receive care from an out-of-network provider.

Congress.gov. H.R.133—Consolidated Appropriations Act, 2021 . Enacted December 27, 2021.

Kona M. The Commonwealth Fund. State balance billing protections . April 20, 2020.

Data.CMS.gov. Opt Out Affidavits .

Chhabra, Karan; Schulman, Kevin A.; Richman, Barak D. Health Affairs. Are Air Ambulances Truly Flying Out Of Reach? Surprise-Billing Policy And The Airline Deregulation Act . October 17, 2019.

Kaiser Family Foundation. 2022 Employer Health Benefits Survey .

Centers for Medicare and Medicaid Services. Members of New Federal Advisory Committee Named to Help Improve Ground Ambulance Disclosure and Billing Practices for Consumers . December 13, 2022.

Centers for Medicare and Medicaid Services. Advisory Committee on Ground Ambulance and Patient Billing (GAPB) .

Internal Revenue Service; Employee Benefits Security Administration; Health and Human Services Department. Requirements Related to Surprise Billing . August 26, 2022.

National Conference of State Legislatures. States Tackling "Balance Billing" Issue . July 2017.

By Elizabeth Davis, RN Elizabeth Davis, RN, is a health insurance expert and patient liaison. She's held board certifications in emergency nursing and infusion nursing.

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What does ‘accepting assignment’ mean?

Accepting assignment is a real concern for those who have Original Medicare coverage. Physicians (or any other healthcare providers or facilities) who accept assignment agree to take Medicare’s payment for services. They cannot bill a Medicare beneficiary in excess of the Medicare allowance, which is the copayment or coinsurance. While providers who participate in the Medicare program must accept assignment on all Medicare claims, they do not have to accept every Medicare beneficiary as a patient. 

There are basically three Medicare options for physicians.

• Physicians may sign a participating agreement and accept Medicare’s allowed charge as payment-in-full for all of their Medicare patients. Use the Physician Compare database to find physicians who accept assignment. 
• They may elect to be non-participating, in which case, they make decisions about accepting Medicare assignment on a case-by-case basis. They can bill patients up to 15% more than the Medicare allowance. Some Medigap policies offer a benefit to cover this amount, known as Part B excess charges.
• Or, they may opt out of Medicare entirely and become private contracting physicians.  They establish contracts with their patients to bill them directly. Neither the physicians nor the patients would receive any payments from Medicare.

Accepting assignment can also be a concern for beneficiaries with coverage other than Original Medicare, including those:

• in a Medicare Advantage Private Fee-for-service (PFFS) plan who get services outside the network.
• in a Medicare Advantage Medical Savings Account (MSA) plan because this plan does not utilize networks.

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What You Need to Know About Medicare Assignment

If you are one of the more than 63 million Americans enrolled in Medicare and are on the lookout for a new provider, you may wonder what your options are. A good place to start? Weighing the pros and cons of choosing an Original Medicare plan versus a Medicare Advantage plan—both of which have their upsides.

Let’s say you decide on an Original Medicare plan, which many U.S. doctors accept. In your research, however, you come across the term “Medicare assignment.” Cue the head-scratching. What exactly does that mean, and how might it affect your coverage costs?

What is Medicare Assignment?

It turns out that Medicare assignment   is a concept you need to understand before seeing a new doctor. First things first: Ask your doctor if they “accept assignment”—that exact phrasing—which means they have agreed to accept a Medicare-approved amount as full payment for any Medicare-covered service provided to you. If your doctor accepts assignment, that means they’ll send your whole medical bill to Medicare, and then Medicare pays 80% of the cost, while you are responsible for the remaining 20%.

A doctor who doesn’t accept assignment, however, could charge up to 15% more than the Medicare-approved amount for their services, depending on what state you live in, shouldering you with not only that additional cost but also your 20% share of the original cost. Additionally, the doctor is supposed to submit your claim to Medicare, but you may have to pay them on the day of service and then file a reimbursement claim from Medicare after the fact.

Worried that your doctor will not accept assignment? Luckily, 98% of U.S. physicians who accept Medicare patients also accept Medicare assignment, according to the U.S. Centers for Medicare & Medicaid Services (CMS). They are known as assignment providers, participating providers, or Medicare-enrolled providers.

It can be confusing. Here’s how to assess whether your provider accepts Medicare assignment, and what that means for your out-of-pocket costs:

The 3 Types of Original Medicare Providers

1. participating providers, or those who accept medicare assignment.

These providers have an agreement with Medicare to accept the Medicare-approved amount as full payment for their services. You don’t have to pay anything other than a copay or coinsurance (depending on your plan) at the time of your visit. Typically, Medicare pays 80% of the cost, while you are responsible for the remaining 20%, as long as you have met your deductible.

2. Non-participating providers

“Most providers accept Medicare, but a small percentage of doctors are known as non-participating providers,” explains Caitlin Donovan, senior director of public relations at the National Patient Advocate Foundation (NPAF) in Washington D.C. “These may be more expensive,” she adds. Also known as non-par providers, these physicians may accept Medicare patients and insurance, but they have not agreed to take assignment Medicare in all cases. That means they’re not held to the Medicare-approved amount as payment in full. As a reminder, a doctor who doesn’t accept assignment can charge up to 15% more than the Medicare-approved amount, depending on what part of the country you live in, and you will have to pay that additional amount plus your 20% share of the original cost.

What does that mean for you? Besides being charged more than the Medicare-approved amount, you might also be required to do some legwork to get reimbursed by Medicare.

• You may have to pay the entire bill at the time of service and wait to be reimbursed 80% of the Medicare-approved amount. In most cases, the provider will submit the claim for you. But sometimes, you’ll have to submit it yourself.
• Depending on the state you live in, the provider may also charge you as much as 15% more than the Medicare-approved amount. (In New York state, for example, that add-on charge is limited to 5%.) This is called a limiting charge—and the difference, called the balance bill, is your responsibility.

There are some non-par providers, however, who accept Medicare assignment   for certain services, on a case-by-case basis. Those may include any of the services—anything from hospital and hospice care to lab tests and surgery—available from any assignment-accepting doctor, with a key exception: If a non-par provider accepts assignment for a particular service, they cannot bill you more than the regular Medicare deductible and coinsurance amount for that specific treatment. Just as it’s important to confirm whether your doctor accepts assignment, it’s also important to confirm which services are included at assignment.

3. Opt-out providers

A small percentage of providers do not participate in Medicare at all. In 2020, for example, only 1% of all non-pediatric physicians nationwide opted out, and of that group, 42% were psychiatrists. “Some doctors opt out of providing Medicare coverage altogether,” notes Donovan.“In that case, the patient would pay privately.” If you were interested in seeing a physician who had opted out of Medicare, you would have to enter a private contract with that provider, and neither you nor the provider would be eligible for reimbursement from Medicare.

How do I know if my doctor accepts Medicare assignment?

The best way to find out whether your provider accepts Medicare assignment is simply to ask. First, confirm whether they are participating or non-participating—and if they are non-participating, ask whether they accept Medicare assignment for certain services.

Also, make sure to ask your provider exactly how they will be billing Medicare and what charges you might expect at the time of your visit so that you’re on the same page from the start.

Is seeing a non-participating provider who accepts Medicare assignment more expensive?

The short answer is yes. There are usually out-of-pocket costs after you’re reimbursed. But it may not cost as much as you think, and it may not be much more than if you see a participating provider. Still, it could be challenging if you’re on a fixed income.

For example, let’s say you’re seeing a physical therapist who accepts Medicare patients but not Medicare assignment. Medicare will pay $95 per visit to the provider; but your provider bills the service at $115. In most states, you’re responsible for a 15% limiting charge above $95. In this case, your bill would be 115% of $95, or $109.25.

Once you get your $95 reimbursement back from Medicare, your cost for the visit—the balance bill—would be $14.25 (plus any deductibles or copays) .

In some states, the maximum cap on the limiting charge is less than 15%. As mentioned earlier, New York state, for instance, allows only a 5% surcharge, which means that physical therapy appointment would cost you just $4.75 extra.

Bottom line: Medicare assignment providers and non-participating providers who agree to accept Medicare assignment are both viable options for patients. So if you want to see a particular provider, don’t rule them out just because they’re non-par.

While seeing a non-participating provider may still be affordable, ultimately, the biggest headache may be keeping track of claims and reimbursements, or simply setting aside the right amount of money to pay for your visit up front.

Before you schedule a visit, be sure to ask how much the service will cost. You can also estimate the payment amount based on Medicare-approved charges. A good place to start is this  out-of-pocket expense calculator  provided by the CMS.

What if I see a provider who opts out of Medicare altogether?

An opt-out provider will create a private contract with you, underscoring the terms of your agreement. But Medicare will not reimburse either of you for services.

Seeing a provider who does not accept Medicare will likely be more expensive. And your visits won’t count toward your deductible. But you may be able to work out paying reduced fees on a sliding scale for that provider’s services, all of which would be laid out in your contract.

Medicare Assignment: Understanding How It Works

Medicare assignment is a term used to describe how a healthcare provider agrees to accept the Medicare-approved amount. Depending on how you get your Medicare coverage, it could be essential to understand what it means and how it can affect you.

What is Medicare assignment?

Medicare sets a fixed cost to pay for every benefit they cover. This amount is called Medicare assignment.

You have the largest healthcare provider network with over 800,000 providers nationwide on Original Medicare . You can see any doctor nationwide that accepts Medicare.

Understanding the differences between your cost and the difference between accepting Medicare and accepting Medicare assignment could be worth thousands of dollars.

Doctors that accept Medicare

Your healthcare provider can fall into one of three categories:

Medicare participating provider and Medicare assignment

Medicare participating providers not accepting medicare assignment, medicare non-participating provider.

More than 97% of healthcare providers nationwide accept Medicare. Because of this, you can see almost any provider throughout the United States without needing referrals.

Let’s discuss the three categories the healthcare providers fall into.

Participating providers are doctors or healthcare providers who accept assignment. This means they will never charge more than the Medicare-approved amount.

Some non-participating providers accept Medicare but not Medicare assignment. This means you can see them the same way a provider accepts assignment.

You need to understand that since they don’t take the assigned amount, they can charge up to 15% more than the Medicare-approved amount.

Since Medicare will only pay the Medicare-approved amount, you’ll be responsible for these charges. The 15% overcharge is called an excess charge. A few states don’t allow or limit the amount or services of the excess charges. Only about 5% of providers charge excess charges.

Opt-out providers don’t accept Original Medicare, and these healthcare providers are in the minority in the United States. If healthcare providers don’t accept Medicare, they won’t be paid by Medicare.

This means choosing to see a provider that doesn’t accept Medicare will leave you responsible for 100% of what they charge you. These providers may be in-network for a Medicare Advantage plan in some cases.

Avoiding excess charges

Excess charges could be large or small depending on the service and the Medicare-approved amount. Avoiding these is easy. The simplest way is to ask your provider if they accept assignment before service.

If they say yes, they don’t issue excess charges. Or, on Medicare.gov , a provider search tool will allow you to look up your healthcare provider and show if they accept Medicare assignment or not.

Medicare Supplement and Medicare assignment

Medigap plans are additional insurance that helps cover your Medicare cost-share . If you are on specific plans, they’ll pay any extra costs from healthcare providers that accept Medicare but not Medicare assigned amount. Most Medicare Supplement plans don’t cover the excess charges.

The top three Medicare Supplement plans cover excess charges if you use a provider that accepts Medicare but not Medicare assignment.

Medicare Advantage and Medicare assignment

Medicare assignment does not affect Medicare Advantage plans since Medicare Advantage is just another way to receive your Medicare benefits. Since your Medicare Advantage plan handles your healthcare benefits, they set the terms.

Most Medicare Advantage plans require you to use network providers. If you go out of the network, you may pay more. If you’re on an HMO, you’d be responsible for the entire charge of the provider not being in the network.

Do all doctors accept Medicare Supplement plans?

All doctors that accept Original Medicare accept Medicare Supplement plans. Some doctors don’t accept Medicare. In this case, those doctors won’t accept Medicare Supplements.

Where can I find doctors who accept Medicare assignment?

Medicare has a physician finder tool that will show if a healthcare provider participates in Medicare and accepts Medicare assignments. Most doctors nationwide do accept assignment and therefore don’t charge the Part B excess charges.

Why do some doctors not accept Medicare?

Some doctors are called concierge doctors. These doctors don’t accept any insurance and require cash payments.

What is a Medicare assignment?

Accepting Medicare assignment means that the healthcare provider has agreed only to charge the approved amount for procedures and services.

What does it mean if a doctor does not accept Medicare assignment?

The doctor can change more than the Medicare-approved amount for procedures and services. You could be responsible for up to a 15% excess charge.

How many doctors accept Medicare assignment?

About 97% of doctors agree to accept assignment nationwide.

Is accepting Medicare the same as accepting Medicare assignment?

No. If a doctor accepts Medicare and accepts Medicare assigned amount, they’ll take what Medicare approves as payment in full.

If they accept Medicare but not Medicare assignment, they can charge an excess charge of up to 15% above the Medicare-approved amount. You could be responsible for this excess charge.

What is the Medicare-approved amount?

The Medicare-approved amount is Medicare’s charge as the maximum for any given medical service or procedure. Medicare has set forth an approved amount for every covered item or service.

Can doctors balance bill patients?

Yes, if that doctor is a Medicare participating provider not accepting Medicare assigned amount. The provider may bill up to 15% more than the Medicare-approved amount.

What happens if a doctor does not accept Medicare?

Doctors that don’t accept Medicare will require you to pay their full cost when using their services. Since these providers are non-participating, Medicare will not pay or reimburse for any services rendered.

Get help avoiding Medicare Part B excess charges

Whether it’s Medicare assignment, or anything related to Medicare, we have licensed agents that specialize in this field standing by to assist.

Give us a call, or fill out our online request form . We are happy to help answer questions, review options, and guide you through the process.

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Assignment of benefits: what you need to know.

• August 17, 2022
• Steven Schwartzapfel

Insurance can be useful, but dealing with the back-and-forth between insurance companies and contractors, medical specialists, and others can be a time-consuming and ultimately unpleasant experience. You want your medical bills to be paid without having to act as a middleman between your healthcare provider and your insurer.

However, there’s a way you can streamline this process. With an assignment of benefits, you can designate your healthcare provider or any other insurance payout recipient as the go-to party for insurance claims. While this can be convenient, there are certain risks to keep in mind as well.

Below, we’ll explore what an assignment of insurance benefits is (as well as other forms of remediation), how it works, and when you should employ it. For more information, or to learn whether you may have a claim against an insurer, contact Schwartzapfel Lawyers now at 1-516-342-2200 .

What Is an Assignment of Benefits?

An assignment of benefits (AOB) is a legal process through which an insured individual or party signs paperwork that designates another party like a contractor, company, or healthcare provider as their insurance claimant .

Suppose you’re injured in a car accident and need to file a claim with your health insurance company for medical bills and related costs. However, you also need plenty of time to recover. The thought of constantly negotiating between your insurance company, your healthcare provider, and anyone else seems draining and unwelcome.

With an assignment of benefits, you can designate your healthcare provider as your insurance claimant. Then, your healthcare provider can request insurance payouts from your healthcare insurance provider directly.

Through this system, the health insurance provider directly pays your physician or hospital rather than paying you. This means you don’t have to pay your healthcare provider. It’s a streamlined, straightforward way to make sure insurance money gets where it needs to go. It also saves you time and prevents you from having to think about insurance payments unless absolutely necessary.

What Does an Assignment of Benefits Mean?

An AOB means that you designate another party as your insurance claimant. In the above example, that’s your healthcare provider, which could be a physician, hospital, or other organization.

With the assignment of insurance coverage, that healthcare provider can then make a claim for insurance payments directly to your insurance company. The insurance company then pays your healthcare provider directly, and you’re removed as the middleman.

As a bonus, this system sometimes cuts down on your overall costs by eliminating certain service fees. Since there’s only one transaction — the transaction between your healthcare provider and your health insurer — there’s only one set of service fees to contend with. You don’t have to deal with two sets of service fees from first receiving money from your insurance provider, then sending that money to your healthcare provider.

Ultimately, the point of an assignment of benefits is to make things easier for you, your insurer, and anyone else involved in the process.

What Types of Insurance Qualify for an Assignment of Benefits?

Most types of commonly held insurance can work with an assignment of benefits. These insurance types include car insurance, healthcare insurance, homeowners insurance, property insurance, and more.

Note that not all insurance companies allow you to use an assignment of benefits. For an assignment of benefits to work, the potential insurance claimant and the insurance company in question must each sign the paperwork and agree to the arrangement. This prevents fraud (to some extent) and ensures that every party goes into the arrangement with clear expectations.

If your insurance company does not accept assignments of benefits, you’ll have to take care of insurance payments the traditional way. There are many reasons why an insurance company may not accept an assignment of benefits.

To speak with a Schwartzapfel Lawyers expert about this directly, call 1-516-342-2200 for a free consultation today. It will be our privilege to assist you with all your legal questions, needs, and recovery efforts.

Who Uses Assignments of Benefits?

Many providers, services, and contractors use assignments of benefits. It’s often in their interests to accept an assignment of benefits since they can get paid for their work more quickly and make critical decisions without having to consult the insurance policyholder first.

Imagine a circumstance in which a homeowner wants a contractor to add a new room to their property. The contractor knows that the scale of the project could increase or shrink depending on the specifics of the job, the weather, and other factors.

If the homeowner uses an assignment of benefits to give the contractor rights to make insurance claims for the project, that contractor can then:

• Bill the insurer directly for their work. This is beneficial since it ensures that the contractor’s employees get paid promptly and they can purchase the supplies they need.
• Make important decisions to ensure that the project completes on time. For example, a contract can authorize another insurance claim for extra supplies without consulting with the homeowner beforehand, saving time and potentially money in the process.

Practically any company or organization that receives payments from insurance companies may choose to take advantage of an assignment of benefits with you. Example companies and providers include:

• Ambulance services
• Drug and biological companies
• Lab diagnostic services
• Hospitals and medical centers like clinics
• Certified medical professionals such as nurse anesthetists, nurse midwives, clinical psychologists, and others
• Ambulatory surgical center services
• Permanent repair and improvement contractors like carpenters, plumbers, roofers, restoration companies, and others
• Auto repair shops and mechanic organizations

Advantages of Using an Assignment of Benefits

An assignment of benefits can be an advantageous contract to employ, especially if you believe that you’ll need to pay a contractor, healthcare provider, and/or other organization via insurance payouts regularly for the near future.

These benefits include but are not limited to:

• Save time for yourself. Again, imagine a circumstance in which you are hospitalized and have to pay your healthcare provider through your health insurance payouts. If you use an assignment of benefits, you don’t have to make the payments personally or oversee the insurance payouts. Instead, you can focus on resting and recovering.
• Possibly save yourself money in the long run. As noted above, an assignment of benefits can help you circumvent some service fees by limiting the number of transactions or money transfers required to ensure everyone is paid on time.
• Increased peace of mind. Many people don’t like having to constantly think about insurance payouts, contacting their insurance company, or negotiating between insurers and contractors/providers. With an assignment of benefits, you can let your insurance company and a contractor or provider work things out between them, though this can lead to applications later down the road.

Because of these benefits, many recovering individuals, car accident victims, homeowners, and others utilize AOB agreements from time to time.

Risks of Using an Assignment of Benefits

Worth mentioning, too, is that an assignment of benefits does carry certain risks you should be aware of before presenting this contract to your insurance company or a contractor or provider. Remember, an assignment of benefits is a legally binding contract unless it is otherwise dissolved (which is technically possible).

The risks of using an assignment of benefits include:

• You give billing control to your healthcare provider, contractor, or another party. This allows them to bill your insurance company for charges that you might not find necessary. For example, a home improvement contractor might bill a homeowner’s insurance company for an unnecessary material or improvement. The homeowner only finds out after the fact and after all the money has been paid, resulting in a higher premium for their insurance policy or more fees than they expected.
• You allow a contractor or service provider to sue your insurance company if the insurer does not want to pay for a certain service or bill. This can happen if the insurance company and contractor or service provider disagree on one or another billable item. Then, you may be dragged into litigation or arbitration you did not agree to in the first place.
• You may lose track of what your insurance company pays for various services . As such, you could be surprised if your health insurance or other insurance premiums and deductibles increase suddenly.

Given these disadvantages, it’s still wise to keep track of insurance payments even if you choose to use an assignment of benefits. For example, you might request that your insurance company keep you up to date on all billable items a contractor or service provider charges for the duration of your treatment or project.

For more on this and related topic, call Schwartzapfel Lawyers now at 1-516-342-2200 .

How To Make Sure an Assignment of Benefits Is Safe

Even though AOBs do carry potential disadvantages, there are ways to make sure that your chosen contract is safe and legally airtight. First, it’s generally a wise idea to contact knowledgeable legal representatives so they can look over your paperwork and ensure that any given assignment of benefits doesn’t contain any loopholes that could be exploited by a service provider or contractor.

The right lawyer can also make sure that an assignment of benefits is legally binding for your insurance provider. To make sure an assignment of benefits is safe, you should perform the following steps:

• Always check for reviews and references before hiring a contractor or service provider, especially if you plan to use an AOB ahead of time. For example, you should stay away if a contractor has a reputation for abusing insurance claims.
• Always get several estimates for work, repairs, or bills. Then, you can compare the estimated bills and see whether one contractor or service provider is likely to be honest about their charges.
• Get all estimates, payment schedules, and project schedules in writing so you can refer back to them later on.
• Don’t let a service provider or contractor pressure you into hiring them for any reason . If they seem overly excited about getting started, they could be trying to rush things along or get you to sign an AOB so that they can start issuing charges to your insurance company.
• Read your assignment of benefits contract fully. Make sure that there aren’t any legal loopholes that a contractor or service provider can take advantage of. An experienced lawyer can help you draft and sign a beneficial AOB contract.

Can You Sue a Party for Abusing an Assignment of Benefits?

Sometimes. If you believe your assignment of benefits is being abused by a contractor or service provider, you may be able to sue them for breaching your contract or even AOB fraud. However, successfully suing for insurance fraud of any kind is often difficult.

Also, you should remember that a contractor or service provider can sue your insurance company if the insurance carrier decides not to pay them. For example, if your insurer decides that a service provider is engaging in billing scams and no longer wishes to make payouts, this could put you in legal hot water.

If you’re not sure whether you have grounds for a lawsuit, contact Schwartzapfel Lawyers today at 1-516-342-2200 . At no charge, we’ll examine the details of your case and provide you with a consultation. Don’t wait. Call now!

Assignment of Benefits FAQs

Which states allow assignments of benefits.

Every state allows you to offer an assignment of benefits to a contractor and/or insurance company. That means, whether you live in New York, Florida, Arizona, California, or some other state, you can rest assured that AOBs are viable tools to streamline the insurance payout process.

Can You Revoke an Assignment of Benefits?

Yes. There may come a time when you need to revoke an assignment of benefits. This may be because you no longer want the provider or contractor to have control over your insurance claims, or because you want to switch providers/contractors.

To revoke an assignment of benefits agreement, you must notify the assignee (i.e., the new insurance claimant). A legally solid assignment of benefits contract should also include terms and rules for this decision. Once more, it’s usually a wise idea to have an experienced lawyer look over an assignment of benefits contract to make sure you don’t miss these by accident.

Contact Schwartzapfel Lawyers Today

An assignment of benefits is an invaluable tool when you need to streamline the insurance claims process. For example, you can designate your healthcare provider as your primary claimant with an assignment of benefits, allowing them to charge your insurance company directly for healthcare costs.

However, there are also risks associated with an assignment of benefits. If you believe a contractor or healthcare provider is charging your insurance company unfairly, you may need legal representatives. Schwartzapfel Lawyers can help.

As knowledgeable New York attorneys who are well-versed in New York insurance law, we’re ready to assist with any and all litigation needs. For a free case evaluation and consultation, contact Schwartzapfel Lawyers today at 1-516-342-2200 !

Schwartzapfel Lawyers, P.C. | Fighting For You™™

What Is an Insurance Claim? | Experian

What is assignment of benefits, and how does it impact insurers? | Insurance Business Mag

Florida Insurance Ruling Sets Precedent for Assignment of Benefits | Law.com

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What is Medicare assignment and how does it work?

Kimberly Lankford,

​Because Medicare decides how much to pay providers for covered services, if the provider agrees to the Medicare-approved amount, even if it is less than they usually charge, they’re accepting assignment.

A doctor who accepts assignment agrees to charge you no more than the amount Medicare has approved for that service. By comparison, a doctor who participates in Medicare but doesn’t accept assignment can potentially charge you up to 15 percent more than the Medicare-approved amount.

That’s why it’s important to ask if a provider accepts assignment before you receive care, even if they accept Medicare patients. If a doctor doesn’t accept assignment, you will pay more for that physician’s services compared with one who does.

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How much do I pay if my doctor accepts assignment?

If your doctor accepts assignment, you will usually pay 20 percent of the Medicare-approved amount for the service, called coinsurance, after you’ve paid the annual deductible. Because Medicare Part B covers doctor and outpatient services, your $240 deductible for Part B in 2024 applies before most coverage begins.

All providers who accept assignment must submit claims directly to Medicare, which pays 80 percent of the approved cost for the service and will bill you the remaining 20 percent. You can get some preventive services and screenings, such as mammograms and colonoscopies , without paying a deductible or coinsurance if the provider accepts assignment. 

What if my doctor doesn’t accept assignment?

A doctor who takes Medicare but doesn’t accept assignment can still treat Medicare patients but won’t always accept the Medicare-approved amount as payment in full.

This means they can charge you up to a maximum of 15 percent more than Medicare pays for the service you receive, called “balance billing.” In this case, you’re responsible for the additional charge, plus the regular 20 percent coinsurance, as your share of the cost.

How to cover the extra cost? If you have a Medicare supplement policy , better known as Medigap, it may cover the extra 15 percent, called Medicare Part B excess charges.

All Medigap policies cover Part B’s 20 percent coinsurance in full or in part. The F and G policies cover the 15 percent excess charges from doctors who don’t accept assignment, but Plan F is no longer available to new enrollees, only those eligible for Medicare before Jan. 1, 2020, even if they haven’t enrolled in Medicare yet. However, anyone who is enrolled in original Medicare can apply for Plan G.

Remember that Medigap policies only cover excess charges for doctors who accept Medicare but don’t accept assignment, and they won’t cover costs for doctors who opt out of Medicare entirely.

Good to know. A few states limit the amount of excess fees a doctor can charge Medicare patients. For example, Massachusetts and Ohio prohibit balance billing, requiring doctors who accept Medicare to take the Medicare-approved amount. New York limits excess charges to 5 percent over the Medicare-approved amount for most services, rather than 15 percent.

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How do I find doctors who accept assignment?

Before you start working with a new doctor, ask whether he or she accepts assignment. About 98 percent of providers billing Medicare are participating providers, which means they accept assignment on all Medicare claims, according to KFF.

You can get help finding doctors and other providers in your area who accept assignment by zip code using Medicare’s Physician Compare tool .

Those who accept assignment have this note under the name: “Charges the Medicare-approved amount (so you pay less out of pocket).” However, not all doctors who accept assignment are accepting new Medicare patients.

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What does it mean if a doctor opts out of Medicare?

Doctors who opt out of Medicare can’t bill Medicare for services you receive. They also aren’t bound by Medicare’s limitations on charges.

In this case, you enter into a private contract with the provider and agree to pay the full bill. Be aware that neither Medicare nor your Medigap plan will reimburse you for these charges.

In 2023, only 1 percent of physicians who aren’t pediatricians opted out of the Medicare program, according to KFF. The percentage is larger for some specialties — 7.7 percent of psychiatrists and 4.2 percent of plastic and reconstructive surgeons have opted out of Medicare.

Keep in mind

These rules apply to original Medicare. Other factors determine costs if you choose to get coverage through a private Medicare Advantage plan . Most Medicare Advantage plans have provider networks, and they may charge more or not cover services from out-of-network providers.

Before choosing a Medicare Advantage plan, find out whether your chosen doctor or provider is covered and identify how much you’ll pay. You can use the Medicare Plan Finder to compare the Medicare Advantage plans and their out-of-pocket costs in your area.

Return to Medicare Q&A main page

Kimberly Lankford is a contributing writer who covers Medicare and personal finance. She wrote about insurance, Medicare, retirement and taxes for more than 20 years at  Kiplinger’s Personal Finance  and has written for  The Washington Post  and  Boston Globe . She received the personal finance Best in Business award from the Society of American Business Editors and Writers and the New York State Society of CPAs’ excellence in financial journalism award for her guide to Medicare.

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Annual Medicare Participation Announcement

Annual Medicare Participation Open Enrollment Period

Read this year's Announcement (PDF) about the annual Medicare participation open enrollment period. 

Every year from mid-November through December 31, providers can decide if they want to participate in Medicare for the upcoming year. In early to mid-November, your MAC will send a post card reminding you about the annual participation open enrollment period. 

We’re proud to share that 98% of providers participate in Medicare. As you plan for 2022, this announcement provides information that may help you determine whether you want to continue or become a Medicare participating (PAR) provider.

We pledge to work with you to put patients first. To do this, we must empower patients and providers to work together to make the best health care decisions for patients. 

Participating vs. Non-Participating Medicare “participation” means you agree to accept claims assignment for all Medicare-covered services to your patients. By accepting assignment, you agree to accept Medicare-allowed amounts as payment in full. You may not collect more from the patient than the Medicare deductible and coinsurance or copayment .  

Choose the situation that applies to you to find out what to do between mid-November and December 31 each year.

You don’t need to do anything.

Complete the Medicare Participating Physician or Supplier Agreement (CMS-460) (PDF) and mail it (or a copy) to each MAC to which you’ll send Part B claims. 

Submit the Medicare Participating Physician or Supplier Agreement (CMS-460) (PDF) electronically with your enrollment application.

Write to each MAC to which you send Part B claims telling them that you’re terminating your participation in Medicare effective January 1. This written notice must be postmarked before December 31 of the previous effective year. 

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If you have Original Medicare , your Part B costs once you have met your deductible can vary depending on the type of provider you see. For cost purposes, there are three types of provider, meaning three different relationships a provider can have with Medicare . A provider’s type determines how much you will pay for Part B -covered services.

• These providers are required to submit a bill (file a claim ) to Medicare for care you receive. Medicare will process the bill and pay your provider directly for your care. If your provider does not file a claim for your care, there are troubleshooting steps to help resolve the problem .
• If you see a participating provider , you are responsible for paying a 20% coinsurance for Medicare-covered services.
• Certain providers, such as clinical social workers and physician assistants, must always take assignment if they accept Medicare.
• Non-participating providers can charge up to 15% more than Medicare’s approved amount for the cost of services you receive (known as the limiting charge ). This means you are responsible for up to 35% (20% coinsurance + 15% limiting charge) of Medicare’s approved amount for covered services.
• Some states may restrict the limiting charge when you see non-participating providers. For example, New York State’s limiting charge is set at 5%, instead of 15%, for most services. For more information, contact your State Health Insurance Assistance Program (SHIP) .
• If you pay the full cost of your care up front, your provider should still submit a bill to Medicare. Afterward, you should receive from Medicare a Medicare Summary Notice (MSN) and reimbursement for 80% of the Medicare-approved amount .
• The limiting charge rules do not apply to durable medical equipment (DME) suppliers . Be sure to learn about the different rules that apply when receiving services from a DME supplier .
• Medicare will not pay for care you receive from an opt-out provider (except in emergencies). You are responsible for the entire cost of your care.
• The provider must give you a private contract describing their charges and confirming that you understand you are responsible for the full cost of your care and that Medicare will not reimburse you.
• Opt-out providers do not bill Medicare for services you receive.
• Many psychiatrists opt out of Medicare.

Providers who take assignment should submit a bill to a Medicare Administrative Contractor (MAC) within one calendar year of the date you received care. If your provider misses the filing deadline, they cannot bill Medicare for the care they provided to you. However, they can still charge you a 20% coinsurance and any applicable deductible amount.

Be sure to ask your provider if they are participating, non-participating, or opt-out. You can also check by using Medicare’s Physician Compare tool .

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What is an insurance assignment?

Assignment — a transfer of legal rights under, or interest in, an insurance policy to another party . In most instances, the assignment of such rights can only be effected with the written consent of the insurer.

How does assignment of insurance work?

What are the two types of assignments in insurance.

• An absolute assignment is typically intended to transfer all your interests, rights and ownership in the policy to an assignee. ...
• A collateral assignment is a more limited type of transfer.

What does assignment mean on a life insurance policy?

A life insurance policy can be assigned when rights of one person are transferred to another . The rights to your insurance policy can be transferred to someone else for various reasons. The process is known as assignment. An “assignor” (policyholder) is the person who assigns the insurance policy.

What is an insurance assignment form?

This form permanently transfers ownership of your FEGLI insurance to another individual, trustee, or corporation (however, premiums continue to be withheld from your salary/annuity). An assignment is irrevocable, and cannot be changed later.

What Is Assignment of Insurance? : Insurance Questions Answered

Why would you assign a life insurance policy?

A life insurance assignment is a document that allows you to transfer the ownership rights of your policy to a third party , transferring to that third party all rights of ownership under your policy, including the rights to make decisions regarding coverage, beneficiary and investment options.

What does it mean to accept assignment of benefits?

“Assignment of Benefits” is a legally binding agreement between you and your Insurance Company, asking them to send your reimbursement checks directly to your doctor. When our office accepts an assignment of benefits, this means that we have to wait for up to one month for your insurance reimbursement to arrive .

What does policy assigned mean?

assign a policy in Insurance If you assign a policy, you transfer legal ownership of an insurance policy to another person . The policy may be assigned to someone else by written request of the current owner.

What is the procedure for assignment in life policy?

Assignment of a life insurance policy may be made by making an endorsement to that effect in the policy document (or) by executing a separate 'Assignment Deed' . In case of assignment deed, stamp duty has to be paid. An Assignment should be signed by the assignor and attested by at least one witness.

What's the difference between nomination and assignment?

Nomination and Assignment serve different purposes. The nomination protects the interests of the insured as well as an insurer in offering claim benefits under the life insurance policy. On the other hand, assignment protects the interests of an assignee in availing the monetary benefits under the policy.

What you mean by assignment?

Definition of assignment 1 : the act of assigning something the assignment of a task. 2a : a position, post, or office to which one is assigned Her assignment was to the embassy in India. b : a specified task or amount of work assigned or undertaken as if assigned by authority a homework assignment.

What are the types of assignment?

• essays. Discover the basic structure of all essays and see what a good essay introduction and conclusion look like.
• Reports. ...
• Literature Reviews. ...
• Annotated Bibliographies. ...
• Reflective Tasks. ...
• Case Studies. ...
• Group work. ...
• group presentation skills.

Can an insurance policy be assigned or transferred?

In insurance also when rights and obligation under the contract are transferred from one to another, the same is called assignment of the policy . There can be another assignment in insurance which is assignment of benefits under the policies. Assignment of policy and assignment of benefits are quite distinct.

Why is assignment of benefits not recommended?

Loopholes in the way AOB is being used are enabling contractors and restoration companies to abuse the practice by inflating claims costs and charging insurance companies for work that was either unnecessary or simply wasn't done at all. These fraudsters then keep any extra money for themselves.

What is the purpose of assignment of benefits?

Assignment of benefits is a legal contract between you and a third party, such as a roofer, contractor, or other vendors. The AOB allows you to transfer specific rights that your insurance policy grants you to a third party .

Can insurance proceeds be assigned?

Most business insurance policies contain a so-called anti-assignment clause . This clause prohibits policyholders from transferring any of their rights under the policy to someone else. This means that the insured business cannot cede its right to collect claim payments to another party.

What is the effect of assignment to the policy owner?

The Assignee has control of the insurance policy as if the Assignee is the Policy Owner. There is no change to the life assured in the policy and the policy remains unaltered .

What do you mean by assignment and transfer of policies?

--(1) A transfer or assignment of a policy of insurance, wholly or in part, whether with or without consideration, may be made only by an endorsement upon the policy itself or by a separate instrument, signed in either case by the transferor or by the assignor or his duly authorised agent and attested by at least one ...

What is conditional assignment in insurance?

Conditional Assignment means that the Transfer of Rights will happen from the Assignor to the Assignee subject to certain terms and conditions . If the conditions are fulfilled then only the Policy will get transferred from the Assignor to the Assignee.

Which of the following are two kinds of assignments?

• Absolute Assignment. An absolute assignment transfers all the rights in the insurance policy to the assignee, including the responsibility to pay any remaining premiums. ...
• Collateral Assignment. ...
• Reasons for Assignment. ...
• Considerations.

What does benefit assigned mean?

Assignment of benefit When a patient assigns their right to the benefit to the servicing provider as full payment for those services .

What is the difference between assignment of benefits and accept assignment?

To accept assignment means that the provider agrees to accept what the insurance company allows or approves as payment in full for the claim. Assignment of benefits means the patient and/or insured authorizes the payer to reimburse the provider directly.

What does it mean to not accept assignment?

A: If your doctor doesn't “accept assignment,” (ie, is a non-participating provider) it means he or she might see Medicare patients and accept Medicare reimbursement as partial payment, but wants to be paid more than the amount that Medicare is willing to pay .

How many types of insurance assignments are there?

There are two types of assignment : Conditional assignment: This is done when the insured wishes to pass benefits of the policy to a relative in case of early death or certain conditions. The rights of the policyholder are restored once the conditions are fulfilled.

What are the consequences of an absolute assignment?

If an absolute assignment was made, the company will pay the entire proceeds to the assignee . If a collateral assignment was made, the company will usually make the check payable jointly to the assignee and the beneficiary.

Assignment of Benefits: What It Is, and How It Can Affect your Property Insurance Claim

Table of Contents

What is an Assignment of Benefits?

In the context of insured property claims, an assignment of benefits (AOB) is an agreement between you and a contractor in which you give the contractor your right to insurance payments for a specific scope of work .  In exchange, the contractor agrees that it will not seek payment from you for that scope of work, except for the amount of any applicable deductible.  In other words, you give part of your insurance claim to your contractor, and your contractor agrees not to collect from you for part of its work.

The most important thing to know about an assignment of benefits is that it puts your contractor in control your claim , at least for their scope of work.  Losing that control can significantly affect the direction and outcome of your claim, so you should fully understand the implications of an AOB (sometimes called an assignment of claims or AOC) before signing one.

How Does an Assignment of Benefits Work in Practice? 

Let’s say you’re an insured homeowner, and Hurricane Ian significantly damaged your roof.  Let’s also assume your homeowner’s policy covers that damage.  A roofer, after inspecting your roof and reviewing your insurance policy, might conclude that your insurer is probably going to pay for a roof replacement under your insurance policy.  The only problem is that it’s early in the recovery process, and your insurer hasn’t yet stated whether it will pay for the roof replacement proposed by your contractor. So if you want your roof replaced now, you would ordinarily agree to pay your roofer for the replacement, and wait in hopes that your insurer reimburses you for the work.  This means that if your insurance company refuses to pay or drags out payment, you’re on the hook to your roofer for the cost of the replacement.

As an alternative to agreeing to pay your roofer for the full cost of the work, you could sign an assignment of benefits for the roof replacement.  In this scenario, your roofer owns the part of your insurance claim that pertains to the roof replacement.  You might have to pay your roofer for the amount of your deductible, but you probably don’t have to pay them for the rest of the cost of the work.  And if your insurance company refuses to pay or drags out payment for the roof replacement, it’s your roofer, and not you, who would be on the hook for that shortfall.

So should you sign an AOB?  Not necessarily.  Read below to understand the pros and cons of an assignment of benefits.

Are There any Downsides to Signing an Assignment of Benefits?

Yes.  

You lose control of your claim . This is the most important factor to understand when considering whether to sign an AOB.  An AOB is a formal assignment of your legal rights to payment under your insurance contract.  Unless you’re able to cancel the AOB, your contractor will have full control over your claim as it relates to their work. 

To explain why that control could matter, let’s go back to the roof replacement example.  When you signed the AOB, the scope of work you agreed on was to replace the roof.  But you’re not a roofing expert, so you don’t know whether the costs charged or the materials used by the roofer in its statement of work are industry appropriate or not.  In most cases, they probably are appropriate, and there’s no problem.  But if they’re not – if, for instance, the roofer’s prices are unreasonably high – then the insurer may not approve coverage for the replacement.  At that point, the roofer could lower its prices so the insurer approves the work, but it doesn’t have to, because it controls the claim .  Instead it could hold up work and threaten to sue your insurer unless it approves the work at the originally proposed price.  Now the entire project is insnared in litigation, leaving you in a tough spot with your insurer for your other claims and, most importantly, with an old leaky roof.

Misunderstanding the Scope of Work.   Another issue that can arise is that you don’t understand the scope of the assignment of benefits.  Contractor estimates and scopes of work are often highly technical documents that can be long on detail but short on clarity.  Contractors are experts at reading and writing them.  You are not.  That difference matters because the extent of your assignment of benefits is based on that technical, difficult-to-understand scope of work.  This can lead to situations where your understanding of what you’re authorizing the contractor to do is very different from what you’ve actually authorized in the AOB agreement.

In many cases, it’s not necessary .   Many contractors will work with you and your insurer to provide a detailed estimate of their work, and will not begin that work until your insurer has approved coverage for it.  This arrangement significantly reduces the risk of you being on the hook for uninsured repairs, without creating any of the potential problems that can occur when you give away your rights to your claim.

Do I have to sign an Assignment of Benefits?

No.  You are absolutely not required to sign an AOB if you do not want to. 

Are There any Benefits to Signing an Assignment of Benefits?

Potentially, but only if you’ve fully vetted your contractor and your claim involves complicated and technical construction issues that you don’t want to deal with. 

First, you must do your homework to fully vet your contractor!  Do not just take their word for it or be duped by slick ads.  Read reviews, understand their certificate of insurance, know where they’re located, and, if possible, ask for and talk to references.  If you’ve determined that the contractor is highly competent at the work they do, is fully insured, and has a good reputation with customers, then that reduces the risk that they’ll abuse their rights to your claim.

Second, if your claim involves complicated reconstruction issues, a reputable contractor may be well equipped to handle the claim and move it forward.  If you don’t want to deal with the hassle of handling a complicated claim like this, and you know you have a good contractor, one way to get rid of that hassle is an AOB.

Another way to get rid of the hassle is to try Claimly, the all-in-one claims handling tool that get you results but keeps you in control of your claim.  

Can my insurance policy restrict the use of AOBs?

Yes, it’s possible that your Florida insurance policy restricts the use of AOBs, but only if all of the following criteria are met:

• When you selected your coverage, your insurer offered you a different policy with the same coverage, only it did not restrict the right to sign an AOB.
• Your insurer made the restricted policy available at a lower cost than the unrestricted policy.
• If the policy completely prohibits AOBs, then it was made available at a lower cost than any policy partially prohibiting AOBs.
• The policy includes on its face the following notice in 18-point uppercase and boldfaced type:

THIS POLICY DOES NOT ALLOW THE UNRESTRICTED ASSIGNMENT OF POST-LOSS INSURANCE BENEFITS. BY SELECTING THIS POLICY, YOU WAIVE YOUR RIGHT TO FREELY ASSIGN OR TRANSFER THE POST-LOSS PROPERTY INSURANCE BENEFITS AVAILABLE UNDER THIS POLICY TO A THIRD PARTY OR TO OTHERWISE FREELY ENTER INTO AN ASSIGNMENT AGREEMENT AS THE TERM IS DEFINED IN SECTION 627.7153 OF THE FLORIDA STATUTES.

627.7153. 

Pro Tip : If you have an electronic copy of your complete insurance policy (not just the declaration page), then search for “policy does not allow the unrestricted assignment” or another phrase from the required language above to see if your policy restricts an AOB.  If your policy doesn’t contain this required language, it probably doesn’t restrict AOBs.

Do I have any rights or protections concerning Assignments of Benefits?

Yes, you do.  Florida recently enacted laws that protect consumers when dealing with an AOB.

Protections in the AOB Contract

To be enforceable, a Assignments of Benefits must meet all of the following requirements:

• Be in writing and executed by and between you and the contractor.
• Contain a provision that allows you to cancel the assignment agreement without a penalty or fee by submitting a written notice of cancellation signed by the you to the assignee:
• at least 30 days after the date work on the property is scheduled to commence if the assignee has not substantially performed, or
• at least 30 days after the execution of the agreement if the agreement does not contain a commencement date and the assignee has not begun substantial work on the property.
• Contain a provision requiring the assignee to provide a copy of the executed assignment agreement to the insurer within 3 business days after the date on which the assignment agreement is executed or the date on which work begins, whichever is earlier.
• Contain a written, itemized, per-unit cost estimate of the services to be performed by the assignee .
• Relate only to work to be performed by the assignee for services to protect, repair, restore, or replace a dwelling or structure or to mitigate against further damage to such property.
• Contain the following notice in 18-point uppercase and boldfaced type:

YOU ARE AGREEING TO GIVE UP CERTAIN RIGHTS YOU HAVE UNDER YOUR INSURANCE POLICY TO A THIRD PARTY, WHICH MAY RESULT IN LITIGATION AGAINST YOUR INSURER. PLEASE READ AND UNDERSTAND THIS DOCUMENT BEFORE SIGNING IT. YOU HAVE THE RIGHT TO CANCEL THIS AGREEMENT WITHOUT PENALTY WITHIN 14 DAYS AFTER THE DATE THIS AGREEMENT IS EXECUTED, AT LEAST 30 DAYS AFTER THE DATE WORK ON THE PROPERTY IS SCHEDULED TO COMMENCE IF THE ASSIGNEE HAS NOT SUBSTANTIALLY PERFORMED, OR AT LEAST 30 DAYS AFTER THE EXECUTION OF THE AGREEMENT IF THE AGREEMENT DOES NOT CONTAIN A COMMENCEMENT DATE AND THE ASSIGNEE HAS NOT BEGUN SUBSTANTIAL WORK ON THE PROPERTY. HOWEVER, YOU ARE OBLIGATED FOR PAYMENT OF ANY CONTRACTED WORK PERFORMED BEFORE THE AGREEMENT IS RESCINDED. THIS AGREEMENT DOES NOT CHANGE YOUR OBLIGATION TO PERFORM THE DUTIES REQUIRED UNDER YOUR PROPERTY INSURANCE POLICY.

• Contain a provision requiring the assignee to indemnify and hold harmless the assignor from all liabilities, damages, losses, and costs, including, but not limited to, attorney fees.

Contractor Duties

Under Florida law, a contractor (or anyone else) receiving rights to a claim under an AOB:

• Must provide you with accurate and up-to-date revised estimates of the scope of work to be performed as supplemental or additional repairs are required.
• Must perform the work in accordance with accepted industry standards.
• May not seek payment from you exceeding the applicable deductible under the policy unless asked the contractor to perform additional work at the your own expense.
• Must, as a condition precedent to filing suit under the policy, and, if required by the insurer, submit to examinations under oath and recorded statements conducted by the insurer or the insurer’s representative that are reasonably necessary, based on the scope of the work and the complexity of the claim, which examinations and recorded statements must be limited to matters related to the services provided, the cost of the services, and the assignment agreement.
• Must, as a condition precedent to filing suit under the policy, and, if required by the insurer, participate in appraisal or other alternative dispute resolution methods in accordance with the terms of the policy.
• If the contractor is making emergency repairs, the assignment of benefits cannot exceed the greater of $3,000 or 1% of your Coverage A limit.

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Brelly’s tools and resources are your secret weapon to getting your insurance claim filed right, moving fast, and paid fully .

Presidential debate fact check: What Trump, Biden got right (and wrong)

President Joe Biden and former President Donald Trump both strayed repeatedly from the truth as they squared off in the first presidential debate of the 2024 election season.

Here are the claims the USA TODAY Fact Check Team dug into.

Biden claim: We lowered the cost of an insulin shot from $400 to $15

“We brought down the price of prescription drugs, which is a major issue for many people, to $15 for – for an insulin shot, as opposed to $400.”

This is false. The Inflation Reduction Act that Biden signed into law in August 2022 capped the out-of-pocket cost of insulin at $35 a month for all seniors on Medicare, according to the White House . Several pharmaceutical companies , including Eli Lilly , followed suit and limited the monthly cost of the drug to $35 per month as well. But there is no evidence Biden limited the cost of insulin beyond this.

The price of insulin was also never set at $400, though many paid about this much. The price a person pays for insulin depends on a variety of factors, including what type of insulin they are using, insurance status and whether they're eligible for a rebate from the drugmaker, according to NBC News . While estimates vary, one government study published in December 2022 reported that in 2019 , the average insulin user with private insurance spent $456 on insulin annually, while those with Medicare spent $449 a year and those without health insurance paid $996, comparatively. 

-Brad Sylvester

Biden claim: He is endorsed by Border Patrol agents

“The border patrolmen endorsed me, endorsed my position.”

This is partly false.

The National Border Patrol Council – the labor union that represents more than 18,000 U.S. Border Patrol agents – posted to X, formerly Twitter , minutes after Biden made the claim and said, “To be clear, we never have and never will endorse Biden.”

But the union, which endorsed Trump in 2020, supported the proposed bipartisan border agreement that Biden backed and Trump opposed, NBC News reported in February.

– Joedy McCreary

Biden claim: Illegal border crossings dropped 40% after his June directive

“I've changed (the law) in a way that now you're in a situation where there are 40% fewer people coming across the border illegally.”

Biden took executive action on June 4 that authorized the U.S. to turn away migrants who enter the country illegally when crossing levels are high. The policy is triggered anytime unlawful crossings hit an average of 2,500 people a day in a given week.

In remarks posted on June 26 , Homeland Security Secretary Alejandro N. Mayorkas said Border Patrol encounters along the U.S.-Mexico border had dropped by over 40% since Biden took action.

However, immigration experts have cautioned that it’s difficult to point to any one reason for a drop in crossings at the border, PolitiFact noted in its fact check on this claim .

Immigration rights organizations have sued the Biden administration over the new asylum restrictions at the border.

–Andre Byik

Trump claim: Everybody wanted Roe v. Wade overturned

“I put three great Supreme Court justices on the court, and they happened to vote in favor of killing Roe v. Wade and moving it back to the states. This is something that everybody wanted.”

This is not an accurate summary of public opinion on the question. Numerous polls show most Americans were not in favor of the Supreme Court overturning Roe v. Wade in June 2022 . For example, a poll conducted by Pew Research Center in July 2022 found that 57% of respondents said they disapproved of the overturning of the landmark decision. Another PBS NewsHour/NPR/Marist poll conducted in May 2022 (before the case was decided) found that 64% of respondents were opposed to reversing Roe v. Wade.

There is little evidence opinions have changed much since the decision. A Marquette Law School poll conducted in February 2024 found that 67% of adults opposed the ruling, while a Gallup poll from June 2023 found that 60% of respondents said overturning Roe v. Wade was a “bad thing.” 

- Brad Sylvester

Biden claim: Historians voted Trump ‘worst’ president in history

“(Trump) was the worst in all of American history. … He can argue (the historians) are wrong, but that’s what they voted.”

Biden was presumably referring to the 2024 Presidential Greatness Project Expert Survey , which is a joint project from University of Houston professor Brandon Rottinghaus and Coastal Carolina University professor Justin Vaughn .

The survey respondents in late 2023 voted Trump the lowest in “overall presidential greatness,” behind James Buchanan, Andrew Johnson and Franklin Pierce. Abraham Lincoln was rated highest. Joe Biden ranked at No. 14.

Respondents included scholars who had recently published peer-reviewed academic research in related scholarly journals or academic presses and current and recent members of the Presidents & Executive Politics Section of the American Political Science Association, which the survey described as “the foremost organization of social science experts in presidential politics.”

Out of 525 respondents invited to participate, the survey received 154 usable responses, yielding a 29% response rate.

– Andre Byik

Trump claim: I brought in National Guard during 2020 Minnesota unrest

“If I didn’t bring in the National Guard, that city (Minneapolis) would have been destroyed.”

It was Minnesota Gov. Tim Walz, a Democrat, who activated the state’s National Guard to respond to unrest following the death of George Floyd, according to a press release issued by Walz’s office on May 28, 2020.

Walz said at the time that he was responding to “local leaders’ request for Minnesota National Guard assistance to protect peaceful demonstrators, neighbors and small businesses in Minnesota.”

CNN reporter Daniel Dale also looked into the claim back in 2020, detailing the timeline of events provided to the network by Walz’s press secretary, Teddy Tschann. In a statement to CNN, Tschann said Walz activated the National Guard at the request of the mayors of Minneapolis and St. Paul, before the governor spoke with the White House.

“Did President Trump ‘call out’ the Guard? No,” Tschann said in the statement, according to CNN.

On May 30, 2020, the Minnesota National Guard posted on Twitter, now X, that Walz had “ announced the full mobilization ” of the Guard for the first time since World War II.

Biden claim: Trump praised Hitler, saying he did 'some good things'

"This is a guy who says Hitler has done some good things"

Biden's quote of Trump is a reference to comments the former president allegedly made while talking with his White House Chief of Staff, John Kelly, in 2018 during a trip to Paris, according to excerpts from an upcoming book by Wall Street Journal reporter Michael Bender.

“Well, Hitler did a lot of good things,” Trump reportedly told Kelly, according to a CNN report .

Trump later denied that he made the comments and denied that the conversation took place. Liz Harrington, a Trump spokesperson, told CNN the claim is "totally false."

"President Trump never said this," Harrington said. "It is made up fake news, probably by a general who was incompetent and was fired."

Trump has previously faced criticism for saying immigrants are “poisoning the blood of our country” and describing his political opponents as "vermin," reminding many of language used by authoritarian leaders .

- Chris Mueller

Trump claim: Record ‘approval rating’ from VA

“I had the highest approval rating in the history of the VA.”

This is both false and a mischaracterization of what the quarterly customer experience surveys from the U.S. Department of Veterans Affairs measure.

The Veteran Signals surveys track the proportion of servicemembers who express having trust in the VA. It's not a presidential approval rating.

It has topped 80% twice: It was at 80% in 2020 during Trump’s administration , and it reached a high of 80.4% in May under Biden.

Trump made a similar version of the claim during a May rally in Wisconsin , according to a report from Wisconsin Watch.

Trump claim: More illicit drugs coming into US under Biden

“The number of drugs coming across our border now is the largest we’ve ever had by far.”

This is false. When measured by weight, drug seizures are trending down.

The U.S. Customs and Border Protection’s Border Patrol and Office of Field Operations seized nearly 549,000 pounds of illicit drugs in 2023 , according to federal data. That’s down 16% from 2022, when 656,000 pounds of substances were confiscated. More than 900,000 pounds were seized in 2021, according to federal data.

Most of the drugs involved were marijuana (150,000 pounds) and methamphetamine (140,000 pounds).

Fentanyl seizures were up, however, with the 27,000 pounds in 2023 accounting for nearly twice the 14,700 pounds confiscated in 2022.

Trump claim: Biden indicted me because I’m his political opponent

“He [Biden] indicted me because I'm his opponent.”

This is false. Trump was indicted and convicted in New York for falsifying business records related to a $130,000 hush money payment to adult film actress Stormy Daniels ahead of the 2016 election. But there is no evidence Biden or his administration had anything to do with these charges. Since the charges were brought by the state of New York , Biden and the federal government are not party to the indictment and have no say in the charges, as USA TODAY previously reported .

“When you’re dealing with state prosecutions, it’s district attorneys elected by the voters of their jurisdiction,” said Allan Lichtman , a professor of history at American University. “That has nothing to do with the federal government.”

The idea of Biden interfering in Trump's prosecution is further weakened by the fact that the agency under his purview declined to file charges. The Justice Department had the authority to pursue a case against Trump over the hush money circumstances but chose not to do so.

In Trump's two federal cases, things are a bit different. The charges he faces cover the  hoarding of hundreds of classified documents  in Florida and a  conspiracy to steal the 2020 election  from Biden in Washington.

There is no law that prohibits a president from involving himself in a federal case, experts acknowledged. But they also said Biden has kept himself separate from the prosecution of Trump .

Additionally, Biden publicly vowed not to speak to Attorney General Merrick Garland about any specific case. And a key reason for the November 2022 appointment of Jack Smith as special counsel for the federal cases against Trump was to add a layer of separation between the investigation and the Biden Administration.

- Brad Sylvester and Joedy McCreary

Trump claim: Food prices have 'doubled and tripled and quadrupled' under Biden

"You look at the cost of food where it's doubled and tripled and quadrupled."

The cost of food has gone up under Biden, but not to the extent Trump claimed. 

The U.S. Department of Agriculture's all-food consumer price index shows food prices rose by 25% from 2019 to 2023. 

The COVID-19 pandemic caused changes in consumer behavior and led to supply chain disruptions, driving large increases in some foods. In 2022, food costs increased faster than any year since 1979, "partly due to a highly pathogenic avian influenza outbreak that affected egg and poultry prices," according to the department's report.

But grocery prices have stabilized over the last year , increasing by just 1.2% in the past 12 months, according to the Consumer Price Index report from March 2024.

Trump claim: No sex with porn star

“I didn’t have sex with a porn star.”

This is disputed.

On May 30, a New York state jury found Trump guilty on 34 felony counts of falsifying business records tied to a hush money payment to porn star Stormy Daniels. Daniels testified at trial that she had sex with Trump in July 2006 following a celebrity golf tournament in Lake Tahoe.

Trump has denied the sex happened.

The trial focused on a $130,000 payment that was arranged by Trump’s then-personal lawyer, Michael Cohen, ahead of the 2016 presidential election, the Associated Press reported.

Trump claim: Biden called African Americans ‘super predators’

"He did a crime bill. 1994. Where you called them super predators. African Americans. Super predators. And they've never forgotten it. They've never forgotten it."

While Biden once warned of “predators” in 1993 while advocating for a 1994 crime bill he sponsored as a senator, he never referred to African Americans as “super predators.” Rather, it was then-first lady Hillary Clinton who linked that term to the 1994 crime bill, as USA TODAY previously reported

While campaigning for her husband in 1996, Clinton praised the 1994 crime bill for curbing gangs, saying, "We need to take these people on, they are often connected to big drug cartels, they are not just gangs of kids anymore. They are often the kinds of kids that are called super predators. No conscious, no empathy,"

Notably, she did not connect this comment to Black people. 

Trump claim: Unprecedented numbers of murders by immigrants under Biden

“People are coming in and they’re killing our citizens at a level that we’ve never seen.”

While Trump has made a version of this claim before, there is no data that points to a wave of homicides being led by people living illegally in the U.S.

A review of 2024 crime data by NBC News suggests the opposite might be true. Overall crime levels have fallen in cities where a Texas program has transported migrants from the border, the network reported in February.

Crime is down year over year in Philadelphia , Chicago , Denver , New York and Los Angeles, according to the report. Washington experienced an increase, but officials do not attribute that spike to migrants, NBC News reported.

Trump previously made a version of the claim during a speech in Eagle Pass, Texas .

Research suggests immigrants actually commit fewer crimes than people born in the U.S.

Trump claim: The US southern border is the most dangerous place in the world

“ We have a border that's the most dangerous place anywhere in the world ”

This is false. While deaths, disappearances and violence do occur at the U.S. southern border, there is no evidence to suggest it is the most dangerous place in the world.

Statistics on border deaths vary. Customs and Border Protection data shows 171 people died at the border in fiscal year 2022, some in CBP custody and others while attempting to cross the border. The International Organization for Migration , a U.N.-related organization , documented 686 deaths and disappearances of migrants on the US-Mexico border in 2022.

Places all over the world and even in the U.S. have more frequent deaths. For example, there were more than 700 murders in Chicago in 2022 , according to the Chicago Police Department. Chicago is 228 square miles , while the U.S.-Mexico border is 1,951 miles long.

Trump claim: Corporate tax cut from 39% to 21%

“The corporate tax was cut down to 21% from 39% plus beyond that.”

Trump was off with one of his numbers. 

The Tax Cuts and Jobs Act of 2017 did lower the corporate tax rate to 21% . But it started at 35%, not the 39% that Trump claimed.

It is unclear exactly what Trump meant with his reference to “plus beyond that.” He promised business leaders that he would lower the corporate tax rate to 20% , The New York Times reported June 13.

Biden claim: Trump told Americans to inject bleach to treat COVID-19

"He said it’s not that serious, just inject a little bleach in your arm, you’ll be all right."

Biden is referring to comments Trump made during a press conference early in the pandemic when he suggested disinfectants might be a possible treatment for COVID-19. But he overstates what Trump said.

Trump's statement came after Bill Bryan, an undersecretary of science and technology at the Department of Homeland Security, discussed a new study that found sunlight and household disinfectants effectively killed the virus on surfaces or in the air.

"And then I saw the disinfectant, where it knocks it out in one minute, and is there a way we could do something like that by injection inside or almost a cleaning," Trump said.

Trump, though, never directly instructed people to inject bleach or any other disinfectant. Some states issued warnings following Trump's comment, as did Lysol, which told people not to inject or ingest its products as a coronavirus treatment.

Biden claim: No American troops died anywhere in the world during his presidency

“The truth is, I’m the only president this century that doesn’t have any - this decade - that doesn’t have any troops dying anywhere in the world, like (former President Donald Trump) did.”

Biden’s comment came following a reference to hostilities in Afghanistan during Trump’s term in office.

But the notion that no troops have died in the world during Biden’s time in office is wrong.

Thirteen U.S. service members were killed in a suicide bombing attack near the Hamid Karzai International Airport in Kabul in August 2021, when Biden was president, as thousands tried to flee the Taliban’s takeover of the country, USA TODAY previously reported.

Among the deaths were 11 Marines, one Navy hospital corpsman and one Army soldier.

Biden remarked on the deaths at the time, calling them “tragic.”

More recently, three U.S. Army Reserve soldiers were killed in January at a base in Jordan in what was described as a drone attack by Iran-backed militants.

Debate background: Hunter Biden's ongoing legal troubles sure to hang over campaign

In early June, a jury found Hunter Biden – Joe Biden's son – guilty of three federal gun charges, making him the first child of a sitting president to be convicted at trial. The situation has been politically charged as it coincides with the elder Biden's ongoing campaign for reelection. 

Republican lawmakers have investigated Hunter Biden's foreign business deals , repeatedly alleging that Joe Biden was involved in influence peddling during his time as vice president. The White House has denied that allegation , calling it baseless innuendo.

Joe Biden, who earlier said he wouldn't pardon his son , released a statement shortly after the jury's verdict was announced reiterating that position.

“I will accept the outcome of this case and will continue to respect the judicial process as Hunter considers an appeal,” he said. “Jill and I will always be there for Hunter and the rest of our family with our love and support. Nothing will ever change that.”

Hunter Biden is expected to stand trial again in September in California, where he faces tax charges.

But even before his legal troubles, the president's son has been a frequent target for misinformation. Here are some of the claims we've already debunked:

• Fact check roundup: After Hunter Biden's guilty verdict, a look back at viral falsehoods
• Claim: Video shows Hunter Biden on the day cocaine was discovered in the White House (False)
• Claim: Hunter Biden’s prison term has been announced (False)
• Claim: Kodak Black and Hunter Biden faced the same charge, but only Black was sentenced to prison (False)
• Claim: Hunter Biden was seen nude on hotel surveillance, chasing and dragging woman (False)
• Claim: Image shows Trump statement on Hunter Biden conviction (Altered)

Debate background: Vast differences between Biden, Trump on gender identity, LGBTQ+ issues

With Pride Month winding down, LGBTQ+ issues – specifically, those related to gender identity – remain pivotal for voters in both parties.

The candidates have taken widely different positions on those issues, with President Joe Biden – hailed as the most LGBTQ-friendly president in U.S. history – marking his first day in office with an executive order on LGBTQ rights .

His administration is challenging Tennessee’s ban on gender-affirming care for minors, with the Supreme Court agreeing to hear the case . He also unveiled in April a set of sweeping changes to Title IX rules that protect LGBTQ+ students from discrimination based on their gender identity, but a federal judge blocked their enforcement in four states .

Meanwhile, former President Donald Trump vowed in May to roll back transgender student protections “on Day 1” of his presidency by reversing an executive order issued by Biden in 2021. Trump also vowed in February 2023 to punish medical professionals and facilities that provide gender-affirming care to transgender minors and said he would support banning transgender women from women’s sports .

Here are some of the false claims related to LGBTQ+ issues that we’ve debunked:

• Claim: NFL coach Mike Tomlin directed team not to participate in Pride Month activities (False)
• Claim: Biden replaced Easter Sunday with Transgender Day of Visibility (False)
• Claim: Joe Biden said he supports allowing kids to have ‘transgender surgery’ at town hall event (False)
• Claim: A Michigan bill would make using a person’s wrong gender pronouns a felony (False)
• Claim: UN chief says Christians who don’t accept pedophilia will be excluded from society (False)
• Claim: Video shows Disney executive announcing company's new pediatric transgender clinics (False)

Debate background: Israel’s war against Hamas sparks unrest in US as peace deal remains elusive

The Hamas attacks on Israel on Oct. 7, 2023, and Israel’s bombardment of the Gaza Strip in response, plunged President Joe Biden into the second major international conflict of his term. He has been forced to balance America’s military support for Israel with calls from the left to broker a ceasefire deal as casualties mount in the Palestinian territory.

Biden said in May that it is “ time for this war to end and for the day after to begin ,” laying out a proposal that called for Israel to cease military operations in the Gaza Strip and Hamas to release hostages in exchange for the release of hundreds of Palestinian prisoners.

But a peace deal has proved elusive , leading to unrest on college campuses across the country after pro-Palestinian demonstrators set up protest camps. Former President Donald Trump cheered police crackdowns on demonstrators, calling them “ a beautiful thing to watch .” But he’s also called on Israel to finish its war, saying the violence is hurting its standing among the international community.

“Israel has to be very careful, because you're losing a lot of the world, you’re losing a lot of support, you have to finish up, you have to get the job done,” Trump told Israeli outlet Israel Hayom in an interview posted in March. "And you have to get on to peace, to get on to a normal life for Israel, and for everybody else.”

These are some claims related to the Israel-Hamas war that we’ve already addressed:

• Claim: Video shows American actress Candice King condemning Rafah “massacre” (False)
• Claim: Indonesia announced it will send troops to protect Palestinians from Israel (False)
• Claim: Image shows ‘mass exodus’ at Ben Gurion Airport amid Israel-Hamas war (False)
• Claim: Israel defense minister announced Israel has “abolished all the rules of war” (False)
• Claim: Video shows a child’s injuries being faked in Israel-Hamas conflict (False)

Debate background: Russia’s invasion of Ukraine puts spotlight on US involvement in foreign wars

Russia’s war against Ukraine entered its third year in February, and the conflict has had political implications in the U.S., where pushes to approve war aid for Ukraine have been met with contentious debate over the extent of American involvement in foreign wars, the Associated Press reported.

President Joe Biden has remained committed to supporting Ukraine and its effort to join NATO, signing a 10-year bilateral security agreement with Ukrainian President Volodymyr Zelenskyy on June 13.

“Our goal is to strengthen Ukraine’s credible defense and deterrence capabilities for the long term,” Biden said at a press conference about the agreement. “A lasting peace for Ukraine must be underwritten by Ukraine’s own ability to defend itself now and to deter future aggression anytime … in the future.”

Former President Donald Trump has said he could end the war within 24 hours of returning to the Oval Office, but he’s offered few details about his plan. The Washington Post reported Trump’s plan could include pressuring Ukraine to give up territory, which Ukraine has opposed.

Here are some fact-checks about claims related to the war in Ukraine:

• Fact check roundup: What's true and false two years after Russia's invasion of Ukraine
• Claim: Video shows Russian military activity 66 miles off Florida coast (False)
• Claim: Italy's Meloni said Russia will be forced to surrender in Ukraine summit speech (False)
• Claim: Image shows Ukrainian girls “recruited into the military” (False)

Debate background: Fight over immigration reform plays out during presidential campaign

Immigration has become one of the most heated topics of the 2024 election, as President Joe Biden grapples with high levels of crossings at the U.S.-Mexico border and former President Donald Trump vows to deport millions of migrants if re-elected.

The situation at the Southwest border – where U.S. Customs and Border Protection recorded nearly 2.5 million migrant encounters in fiscal 2023 – prompted Biden to take executive action earlier this month to implement new restrictions on asylum access .

The action came after Republican lawmakers in February blocked an immigration bill blocked by Biden that would have revamped the country’s immigration and border policies.

Biden blamed the legislation’s failure to gain traction in Congress on opposition from Trump.

“Now, all indications are this bill won't even move forward to the Senate floor,” Biden said at the time . “Why? A simple reason. Donald Trump. Because Donald Trump thinks it's bad for him politically.”

Meanwhile, Trump has pledged to reinstate policies from his first term in office and limit asylum access if elected in November. He also wants to institute a merit-based immigration system and deputize the National Guard and local law enforcement “to assist with rapidly removing illegal alien gang members and criminals,” according to his campaign website.

Here are some immigration-related claims we previously debunked:

• Claim: Nearly 11,000 “illegals” were processed in Eagle Pass, Texas, in one day in mid-March 2024 (False)
• Claim: Nikki Haley opposed a wall on the US border (False)
• Claim: The Texas National Guard has deployed tanks to the border with Mexico (False)
• Claim: Putin said in Carlson interview that Russians find it ‘amusing’ US protects foreign borders, but not its own (False)
• Claim: Video shows US trucker convoy traveling to southern border to stop migrant “invasion” (False)

Debate background: Biden and Trump face age-related concerns, though both insist they're fit to serve

At 81 years old, Joe Biden is currently the oldest U.S. president ever elected . His age has been a concern for voters and a frequent target for critics, including Donald Trump, who often suggests Biden's age makes him unfit to be president. 

Trump is 78 years old , three years younger than Biden, but he has also faced criticism related to his age and mental acuity, including when he confused Joe Biden for Barack Obama in multiple campaign speeches. 

Either man would be the oldest person to take the oath of office if sworn in next January.

In February, Justice Department special counsel Robert Hur released a report indicating Biden wouldn't face charges for his handling of classified documents that included multiple comments about Biden's age and memory, describing him as an elderly man with "diminished capacities," including memory loss. However, Biden and his administration pushed back , with Biden saying his "memory is fine" during a televised speech.

While Trump's doctor said multiple times he was healthy during his presidency, there were – and still are –  reports of him slurring words during his speeches. Late in his term, Trump was recorded slowly descending a ramp after a speech at at U.S. Military Academy at West Point, during which he used both hands to drink a glass of water. Trump dismissed concerns raised about his age after that incident, claiming the ramp was long, steep and "very slippery."

Here are a few of the age-related claims we've already addressed:

• Claim: Image shows Trump needed help to walk across stage (False)
• Claim: Biden demanded he 'not have to stand' during debate with Trump (False)
• Claim: Video shows Biden tried to sit in a nonexistent chair at D-Day ceremony in France (False)
• Claim: Biden agreed to resign if he fails a cognitive test (False)
• Claim: Joe Biden was declared 'mentally unfit' to stand trial (False)

Debate background: Election integrity remains key issue – even without evidence of widespread voter fraud

Throughout the campaign one question has persisted: Will the candidates and their supporters trust – and abide by – the results of the election?

Most recently, former President Donald Trump’s campaign and the Republican National Committee led by his daughter-in-law said they will mobilize 100,000 people in battleground states to ensure “transparency and fairness.” The move has drawn criticism from opponents who say it has the potential to lead to voter intimidation .

State-level recounts, reviews and audits of the 2022 midterm elections found no indication of systemic problems with voter fraud. That’s significant because baseless allegations from Trump and his allies have penetrated the Republican Party and eroded confidence in the process.

Claims questioning the integrity of the election frequently center around a handful of predictable themes that include assertions of widespread voter fraud and election “hacking .”

USA TODAY has debunked several false claims about the integrity of the elections:

• Fact check roundup: False claims about election fraud, candidates swirl amid 2022 midterms
• Claim: 105% of Michigan’s population is registered to vote (False)
• Claim: A software company's contract allows officials to override election results (False)
• Claim: Malware, remote access caused printer problems; 200,000 'ejected' ballots in Arizona (False)
• Claim: A chart shows election fraud in the Michigan AG’s race (False)
• Claim: Blackout in live stream in Nevada points to election theft (False)
• Claim: Fraud due to Texas voting machine adding voters as polls close (False)
• Claim: Photo showing ballots from 2022 midterms in the trash is evidence of fraud (False)
• Claim: Democrats used 47 million mail-in ballots to steal every election (False)
• Claim: Joe Biden did not legally win the presidential election (False)

Debate background: Trump’s conviction, pending trials loom over debate, election

The first former U.S. president convicted of a felony will take the debate stage as an ex-president for the first time in an attempt to convince voters to give him his old job back.

Former President Donald Trump’s felony conviction and his three pending criminal trials continue to loom large over both the race and the debate – his first of the presidential election cycle – with President Joe Biden.

Trump was convicted of 34 counts of falsifying business records related to hush-money payments intended to silence two women , including adult film actress Stormy Daniels, before the 2016 election. Days before the debate, the judge in that case lifted the gag order restrictions that protected the witnesses and jurors. He is scheduled to be sentenced July 11 – days before the start of the Republican National Convention , during which he is expected to formally receive the party’s nomination.

Trump also faces charges for allegedly mishandling classified documents and allegedly conspiring to steal the 2020 presidential election , including his role in the Jan. 6 insurrection . Trump and several allies were indicted in August by a Georgia grand jury that accused them of trying to overturn his 2020 election loss in the state, where Trump lost to President Joe Biden by about 12,000 votes.

Trump’s legal problems have been the subject of an array of false or misleading claims on social media:

• Fact check roundup: Donald Trump guilty verdict spurs false claims
• Claim: The jury in Trump's hush money trial did not need a unanimous verdict to convict (False)
• Claim: Trump ‘blew off his post-sentencing probation report ’ (False)
• Claim: Justice Juan Merchan was ‘fired’ after jury in Trump hush-money trial illegally leaked verdict (False)
• Claim: Texas Constitution prohibits Trump from running for president (False)
• Claim: Post implies Biden can pardon Trump (Missing context)

More from the Fact-Check Team: How we pick and research claims | Email newsletter | Facebook page

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Covington & Burling LLP operates as a limited liability partnership worldwide, with the practice in England and Wales conducted by an affiliated limited liability multinational partnership, Covington & Burling LLP, which is formed under the laws of the State of Delaware in the United States and authorized and regulated by the Solicitors Regulation Authority with registration number 77071..

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How can we help you, navigating pfas liability: emerging regulations, litigation risks, and insurance coverage strategies.

Alert June 27, 2024

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June 27, 2024, Covington Alert

Per- and poly-fluoroalkyl substances (PFAS)—sometimes referred to as “forever chemicals”—have garnered significant attention in recent years, becoming a focus of government regulation and a deluge of civil litigation targeting a wide array of industries. As with any developing area of risk, it is critical that companies assess what insurance coverage they have for PFAS-related risks; allegations of PFAS exposure can trigger decades of potentially available insurance coverage. Policyholders across industries are taking steps to assess their exposure to PFAS liability and to evaluate the insurance coverage that may respond to any PFAS-related claims.

Recent Developments

The science concerning the human health and environmental effects of PFAS has progressed significantly over the last two decades. For example, in 2024, environmental and other regulators took significant action on PFAS:

• In February, the Food and Drug Administration announced a voluntary ban on PFAS-containing food packaging, such as takeout containers, microwave popcorn bags, and fast-food wrappers, in the U.S.
• In April, the Environmental Protection Agency set its first regulatory limits on six types of PFAS in drinking water. The EPA also designated two types of PFAS as CERCLA hazardous substances, paving the way for future contribution actions under environmental cost-recovery statutes.

This increased regulatory activity has coincided with an influx of civil lawsuits targeting both manufacturers and sellers of products that allegedly contain or degrade into PFAS, as well as the companies that manufacture or distribute PFAS. While those lawsuits have met mixed success, they continue to be filed at a rapid pace—to name just a few:

• In January, kombucha manufacturer Health-Ade was sued in New York federal court by a consumer alleging that its drinks contain PFAS. See Morton v. Health-Ade, LLC , Cas. No. 7:24-cv-00173 (S.D.N.Y.).
• In May, BIC was sued for failing to warn consumers that it allegedly uses PFAS in its disposable shaving razors. See Butler v. BIC USA INC. , No. 24-cv-2955 (N.D. Cal.).
• In June, natural toothpaste company RiseWell LLC was sued by a putative class of consumers, alleging that its toothpaste—advertised as “natural” and “safe to swallow”—contained PFAS. See Watkins et al. v. Illuminati Labs LLC et al ., Case No. 5:24-cv-03529 (N.D. Cal.).

Dozens of similar lawsuits have been filed in recent years, alleging the presence of PFAS in fruit juice, cosmetics, hygiene products, school uniforms, and food packaging, among many other products. Because PFAS has been used in a wide variety of products and industries since the 1940s (including nonstick pans, stain-resistant clothes, carpeting, furniture, dental floss, and food packaging, to name only a few), companies in virtually every industry may have exposure to such lawsuits.

PFAS Insurance Implications

PFAS liability presents unique and sometimes novel issues for insurance coverage. While there are few judicial decisions applying key insurance concepts to this new and growing form of liability, there are insurance issues that policyholders can consider and prepare for even before a claim arises.

• Assessing PFAS Exposure : PFAS claimants may allege exposure to PFAS over many decades, potentially from commercial activities or businesses that the policyholder exited long ago. Identifying PFAS used in the policyholder’s current and past commercial activities, by its suppliers or subsidiaries, and by any of other entities for which it might be responsible, is a key component of assessing the company’s overall PFAS exposure.
• Preparing for Potential Insurance Claims : Coverage for PFAS-related liability may be provided by policies that are no longer easily accessible, either because they were issued to now defunct entities or by the sheer passage of time. Identifying historical policies, as well as insurance policies to which the policyholder may have been designated as an “additional insured” (such as those purchased by vendors or other contractual counterparties), can provide access to significant insurance. Reviewing potentially applicable policies before a claim arises also may help to ensure compliance with any potential notice and cooperation conditions, which may be necessary to preserve recovery.
• Assessing Available Coverage and Pollution Exclusions : Many insurers have denied coverage for their policyholder’s PFAS liability on the ground that PFAS is a “pollutant” subject to their policies’ pollution exclusions. While the case law applying such exclusions to PFAS is still developing and varies by State, under most pollution exclusion language, policyholders may have strong arguments for coverage of their PFAS-related liability. For example, such exclusions may not apply where the policyholder’s PFAS liability arises from the intended use of its product, rather than waste emissions from industrial facilities.

Covington’s Insurance Practice

Whether your company is currently responding to PFAS claims or is considering how to assess and prepare for potential claims in the future, Covington’s award-winning insurance recovery team can help. Covington is the leading policyholder firm assisting clients with PFAS-related coverage and represents companies facing all manner of potential PFAS liabilities.

• Covington represents Tyco Fire Products in PFAS coverage litigation. Although this litigation is ongoing, Covington has already negotiated a number of coverage settlements together totaling hundreds of millions of dollars and secured key rulings in favor of coverage for Tyco, including “all sums” allocation across client’s coverage and a ruling that the scope of a prior release did not apply to PFAS claims.
• Covington has been selected as special insurance coverage counsel in connection with the bankruptcy of Kidde-Fenwal in an adversary proceeding seeking coverage for claims arising out of AFFF. 
• Covington represents clients in several confidential PFAS matters seeking to secure insurance coverage without the need for litigation.

Although Covington’s multi-disciplinary team is uniquely prepared to litigate the largest and most complex coverage actions across the country, Covington also boasts a track record of obtaining significant recovery for those liabilities without costly and public litigation. Covington’s success in these and many other insurance disputes has led to its insurance practice group being ranked by Chambers and Partners as the only “Band 1” insurance practice group in the nation for 18 straight years, and to the group being recognized as Law360 ’s 2023 “Practice Group of the Year” and Business Insurance ’s 2023 “Legal Team of the Year.”

If you have any questions concerning the material discussed in this client alert, please contact the members of our Insurance Recovery practice working on PFAS-related matters.

Related Professionals

Benedict M. Lenhart

Alexis N. Dyschkant

Ryan Buschell

Special Counsel

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