What does a participating physician agree to regarding payment?

A participating physician agrees to accept assignment, meaning they accept the payment terms set by the insurance company as full payment for covered services. When physicians are part of a network of providers for specific insurance plans, they commit to providing services at negotiated rates. This arrangement benefits both the physician and the patient; patients typically pay lower out-of-pocket costs, such as copayments or deductibles, because the physician is contracted to accept a certain fee from the insurer rather than charging the patient directly the full amount that might be billed.

In contrast, the other choices illustrate different arrangements that do not involve accepting assignment. For instance, if payment is sent to the patient, the physician may not have any control over how much they get reimbursed, as the patient may not pass the full insurance payment onto the physician. Demanding full upfront payment indicates that the physician is not working within the insurance framework at all, while refusing insurance plans suggests a lack of participation in the network. Acceptance of assignment ensures a smoother process for billing and reimbursement, which is crucial in the healthcare payment landscape.