Vision plan reimbursements can go to one of two places: the patient or the provider. Assignment of Benefits (AOB) is the identification of where that reimbursement goes.
Even though AOB is a state-by-state regulatory requirement, few vision plans offer this functionality. In fact, VSP and Cigna Vision (administered by VSP) reliably and correctly allow AOB for their out-of-network claims. Other vision plans do not.
Is AOB for me?
Certain practices like to assign benefits to themselves because:
It closely resembles an in-network experience even though you are out-of-network
The patient pays a smaller portion out-of-pocket upfront, decreasing the out-of-pocket payment on the spot
Patients will not be following up to check on their reimbursements as you've already applied it in the form of a discount upfront
Some practices have found this process increases their capture rate and improves their sales.
But there are also downsides to this.
Assigning benefits to the practice puts the reimbursement risk on the practice (i.e. if the reimbursement is less or doesn't come at all, the practice must write that off)
If the reimbursement amount is different than quoted, this can be an accounting and collections challenge
Taking on the burden of administering reimbursement checks is a drain on your resources and time consuming
Most practices prefer not to take on this burden and risk. You must do what is right for your specific use case. We will work with you to setup the best process for your practice, though we are not responsible for the risks associated with insurance reimbursements.
Activating AOB for your account
By default, AOB is disabled on all accounts. You must reach out to our team to enable it. In doing so, we will confirm your practice's information, such as the Tax ID, address, and more to ensure your claims are processed properly.
How to toggle patient/provider AOB
AOB can be toggled in two places.
Benefits page: the vision benefits page by selecting the icon representing a person with a dollar sign:
Claim form: directly on the claim form as a toggle in the first section
IMPORTANT: the toggle setting you select will remain the same for future claims unless it is changed by you.