Advance Beneficiary Notice
Frequently Asked Questions
What is an Advance Beneficiary Notice (ABN)?
An ABN is a written form that you may receive from physicians, providers, or suppliers, before they furnish a service or item to you, notifying you that:
Medicare may not pay for the ordered specific service or item, in your case.
The reason the physician, provider, or supplier expects Medicare may deny payment.
The amount you may have to pay out-of-pocket for the service if Medicare denies payment.
An ABN also gives you the opportunity to refuse to receive the service or item.
How does receiving an ABN help me?
The ABN protects you from unexpected financial liability in cases where Medicare denies payment. The “bad news” is that Medicare probably will not pay. The “good news” is that you now have the opportunity to choose whether or not to receive the service or item.
The ABN helps you to make an informed consumer decision about whether to obtain the service or item and be prepared to pay for it (that is, either out of your own pocket or by your other insurance coverage) or to choose not to receive it.
The ABN allows you to have your claim reviewed by Medicare if you do receive the service or item. This also means that you will have the right to appeal Medicare’s decision.
If I receive an ABN, does that mean I should not accept the service or item?
No, not necessarily. You need to make a choice. An ABN means that your hospital, physician, or provider expects that Medicare will not pay. Medicare only pays for covered items and services when Medicare’s medical necessity rules are met. The fact that Medicare may not pay for a particular item or service does not mean that you should not receive it. There may be a good reason your doctor recommended it. It is up to you to decide whether to receive it.
If I receive an ABN, what are my options?
You may choose to receive the service or item. Your claim will be sent to Medicare. If Medicare denies payment, you may be personally and fully responsible for payment. You will have the right to appeal Medicare’s decision. Medicare will not decide whether to pay unless you receive the service or item and have a claim submitted.
You may choose not to receive the service or item. If you choose Option two, your claim will not be sent to Medicare. You will not be able to appeal the supplier’s, physician’s, or provider’s opinion that Medicare won’t pay.
What if I refuse to sign the ABN but I want the service or item anyway?
If you want the service or item, you should sign and date the ABN. If you refuse to sign, you may have a second person witness your refusal to sign the agreement. If an ABN being given to you is witnessed, you may be held liable because you are on notice of the likelihood of a Medicare denial. This is what makes you liable under the law.
