Use this form if you receive a surprise bill for health care services and want the services to be treated as in network. Use this form to assign benefits to a service provider in order to receive reimbursement for services received.Our usual practice is to reimburse. 1. In order to assign benefits directly to your provider, please complete the attached AOB form. 2. How to fill out the Assignment of Benefits and Release of Information Form? 1. Read the form instructions and terms carefully. 2.