Medicare – Advance Beneficiary Notice
Posted on July 27, 2011 by bob in Medicare
Dear Marci,
My provider just asked me to sign an Advance Beneficiary Notice. What does this form do?
— Marjorie
Dear Marjorie,
An Advance Beneficiary Notice (ABN), also known as a “waiver of liability,” is a notice that suppliers and other medical providers are required to give you when they offer you services or items that they know or have reason to believe Medicare will determine to be medically unnecessary for you, and therefore, will not cover.
Providers are not required to give you an ABN for services or items explicitly excluded from Medicare coverage. In addition, ABNs apply only if you are in Original Medicare, not if you are in a Medicare private health plan (HMO, PPO or PFFS).
If you do not get an ABN to sign before you get the service or item from your provider, it is not specifically excluded from coverage, and Medicare does not pay for it, then you do not have to pay for it. You may need to file an appeal to show that you should not have to pay.
If the provider does give you an ABN that you sign before you get the service or item, and Medicare does not pay for it, then you will have to pay your provider for it.
There will be an option on the ABN to check whether or not you want your doctor to submit a claim to Medicare for the service. You should always select that you want your doctor to submit the claim to Medicare. If you do not, your doctor is not required to submit the claim. You should check this option, because Medicare may still pay for the services after all.
If you sign an ABN but ask your doctor to bill Medicare, and Medicare then denies coverage, you can always appeal.
Marci’s Medicare Answers is a service of the Medicare Rights Center (www.medicarerights.org), the nation’s largest independent source of information and assistance for people with Medicare. To speak with a counselor, call (800) 333-4114. To subscribe to “Dear Marci,” the Medicare Rights Center’s free educational e-newsletter, simply e-mail dearmarci@medicarerights.org. To learn more about the services that Medicare will cover and how to change plans, log on to Medicare Interactive Counselor at the Medicare Rights Center’s website at www.medicareinteractive.org.
