Advance Beneficiary Notice (ABN)
FAQs for Patients
What is an Advance Beneficiary Notice?
An ABN gives you information to make an informed choice about whether or not to get items or services, understanding that you may have to accept responsibility for payment. You may get ABN from your doctor, other healthcare provider, or supplier if both of these apply:
You have Original Medicare.
Your doctor, other healthcare provider, or supplier thinks Medicare probably (or certainly) won't pay for the items or services you got. An ABN isn't required for items or services that Medicare never covers.
The ABN lists:
The items or services that Medicare isn't expected to pay for;
An estimate of the costs for the items and services;
The reasons why Medicare may not pay.
How does Medicare determine which services are covered?
Medicare has guidelines to determine if it will cover certain healthcare services. Whether Medicare will cover the recommended service or not depends on your medical condition, and in some cases, the number of times you have had a given test or procedure.
When will I receive an ABN?
If you need a service that might not be covered by Medicare, your healthcare provider will ask you to sign an ABN. The ABN lists the service(s) that may not be covered, as well as the approximate cost of the service(s). You and your provider will review the ABN, and you will decide whether to proceed with the service(s) as recommended.
It’s also important to know that Medicare never covers certain services, such as a complete physical. An ABN form may not be provided in these cases, but as the patient, you are still financially responsible.
What do I do if I receive an ABN?
You’ll be asked to choose an option box and sign the notice to say that you read and understood it. You must choose one of these options:
Option 1: You want the items or services that may not be paid for by Medicare. Your provider or supplier may ask you to pay for them now, but you also want them to submit a claim to Medicare for the items or services. If Medicare denies payment, you’re responsible for paying, but, since a claim was submitted, you can appeal to Medicare.
Option 2: You want the items or services that may not be paid for by Medicare, but you don’t want your provider or supplier to bill Medicare. You may be asked to pay for the items or services now, but because you request your provider or supplier to not submit a claim to Medicare, you can’t file an appeal.
Option 3: You don’t want the items or services that may not be paid for by Medicare, and you aren’t responsible for any payments. A claim isn’t submitted to Medicare, and you can’t file an appeal.
What happens if I choose to receive a non-covered service?
Once you sign the ABN and agree to pay for the service, it will be provided to you. If you choose to have your provider send a bill and Medicare denies payment, you'll have to pay for them yourself unless you have other insurance.
What if I refuse to sign the ABN?
If you decide not to sign the ABN, but decide that you want the service, you will have to pay for it yourself.
If Medicare will not pay for a service, does that mean I do not need it?
No. Doctors base their recommendations on your personal medical history, medications you are taking, and many other factors not taken into consideration by Medicare. Your doctor recommends tests, procedures and other services that he or she feels will provide the best care for you, regardless of whether Medicare feels they are necessary. If you have further questions or concerns, please ask your doctor.
What if I have questions?
Please call your doctor’s office with any questions about your care. For more information about the ABN, call 717-544-4953.