Tweedy Insurance Group

These three little letters may save you a lot of money and headache. ABN stands for Advance Beneficiary Notice. We often get the following question, "My doctor told me that since Medicare did not cover my procedure I have to pay for it out of my pocket. Is that true?" The answer to that question has everything to do with an Advance Beneficiary Notice.

There are thousands of medical procedures that Medicare covers. There are also some that they don't. These might include elective procedures or experimental procedures for example. When obtaining service from a provider, it is always a good idea to ask if the service is covered by Medicare. Your doctor or service provider is the best person to ask about what Medicare covers. Since they depend on getting paid from Medicare, they must know what Medicare will and will not pay for. However, at times a provider can make a mistake and provide you with a service that, once billed to Medicare, is not covered. If this happens you are generally not liable for those charges. There are two exceptions to this rule: 1) if it is a procedure that Medicare never covers, or 2) if you signed an Advance Beneficiary Notice (ABN).

An ABN says, in short, that you are aware that the procedure you are getting ready to have may not be covered by Medicare but that you want to go ahead with it anyway. This releases the provider from the liability of the charge in the event that Medicare doesn't approve the service. However, if you don't sign an ABN and Medicare denies the claim, you are not liable for those charges.

There are some providers out there, however, who try to circumvent this problem by having you sign an ABN upon arriving at their office. Not so fast... Here are a few things you need to know about an ABN.

The ABN must describe the service. That is, you cannot sign an all-inclusive ABN that would cover a whole list of services. The ABN must detail precisely which service may not be covered.
The ABN must include the estimated cost of the service. Never sign an ABN that doesn't tell you how much you will be liable for if Medicare denies the claim.
The ABN must be provided in advance. If a provider wants you to sign an ABN after you have already received the service, do not sign.

In short, be aware of what you are signing when a provider gives you a stack of paperwork. If you see an ABN form, read it carefully and don't hesitate to ask questions. One final note; an ABN only applies to persons covered under Original Medicare (Parts A & B). If you are covered by a Medicare Advantage Plan, you generally have to pay for services that the plan doesn't approve.

Click here to see a sample ABN form, or here to read a detailed Medicare publication regarding ABN forms.