Question

Who must sign the assignment of benefits? Is it necessary to have the insurance subscriber sign an assignment of benefits and release of dental information form if the spouse and children are patients, but the subscriber is not?

Most dental practices simply rely on the patient’s signature. A spouse is able to sign the assignment of benefits for herself and for dependent children, as if they are the insured. However, it is important to obtain and keep a copy of the photo ID (i.e., driver’s license) of the spouse/patient to verify the identity of the individual using the insurance card. There have been cases where a patient has “borrowed” an insured’s identity and insurance card in order to use the insured’s benefits. In several cases the provider has been required to reimburse the payer for payments made for the “imposter’s care” because the practice failed to verify the identity of the patient.

A subscriber does not have to sign a “standing” authorization to release patient information for a spouse except in cases where the subscriber has power of attorney for the patient, or if the patient is a minor. Under HIPAA, once a patient signs an acknowledgement of the provider’s Notice of Privacy Practice, unless the patient has paid for services in full at the time of treatment and requested in writing that the provider not bill the dental plan, the provider does not need a separate authorization to release patient information to the payer, since this is allowed as an integral part of the treatment, payment, and healthcare operations.

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