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Now displaying: Page 1
Aug 5, 2016

Welcome Medicare Nation!

Today, I will be discussing Advance Beneficiary Notices.

An Advance Beneficiary Notice (ABN), also known as a waiver of liability is a notice you should receive when a provider or supplier offers you a service or item they believe Medicare will not cover.

ABNs only apply if you have Original Medicare, are on a Medicare Supplement Plan. ABNs do not apply if you are in a Medicare Advantage private health plan. If you receive an ABN and you're on a Medicare Advantage Plan, ask to speak to the office manager.

Providers must give you an ABN when the service or item could be covered by Medicare, but the provider expects that Medicare will not find the care to be medically necessary and will, therefore, deny coverage.

The ABN must list the reason why the provider doubts Medicare will cover care. For example, an ABN might say, “Medicare only pays for this test once every ten years.” That would be the case for a colonoscopy, since Medicare pays for a low-risk colonoscopy once every ten years.

You should not be receiving an ABN for services or items that are never covered by Medicare, such as hearing aids. 

In order to receive an official decision from Medicare, you must:

1. First receive the care or receive the item                                                       2. You must sign the ABN form, agreeing to pay for it yourself if Medicare rejects       coverage.

Also, you must select Option 1 on the ABN form in order for the doctor or supplier to bill Medicare! Selecting this option requires your provider to bill Medicare after providing you with the service or item.

If you don't select Option 1 on the ABN, you have no chance, nada, zilch chance of Medicare coverage because your doctor is not required to submit the claim.

You will receive a Medicare Summary Notice (MSN) from Medicare. The Medicare Summary Notice will show if Medicare has denied payment for a service or item.   If Medicare denies your claim, you should file an appeal.

Just because you filled out an ABN does not prevent you from filing an appeal.

Medicare has specific rules about an ABN and how it should look. If these rules are not followed, there is a good chance you may not be responsible for the cost of the care. Remember, first you will have to file an appeal to prove your case.

Here are a few reasons you would not be responsible for the charges on an ABN

  • Is difficult to read or hard to understand.
  • Is given by the provider (except a lab) to every single patient with no reason to believe the claims may be denied by Medicare.
  • The ABN does not list the actual service provided 
  • The ABN is signed after the date the service was provided.
  • The ABN is handed to you during an emergency or is handed to you just prior to receiving a service (ex:You're on the xray table & they hand you an ABN)
  • An ABN was not given to you when it should have.

 You can file an appeal by going to your Medicare Supplement website and search for Appeal Form, call your Medicare Supplement Health Insurance Carrier or you can call Medicare at 800-633-4227 and ask them to mail you an appeal form.

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