What is an Advance Beneficiary Notice?
When you take your car in for a check-up, the mechanic tells you that he will call you before he does any major repair work. You authorize that work over the phone after he tells you how much it will cost. That way, you don't get a nasty surprise in the form of a big repair bill you didn't expect.
In a certain way, this is the idea behind Original Medicare's Advance Beneficiary Notice (ABN). This is a written notice you receive from a doctor, supplier, or service provider. It tells you that you are about to receive care, supplies, treatment, or a service that probably will not be covered by Medicare. You will be asked to read this notice. There are "option boxes" that you must check to show that you want the service. You will also be asked to sign the notice, and acknowledge that you understand that you will have to pay for the services or supplies if Original Medicare does not pay.
An ABN isn't an official denial of coverage by Medicare. You could choose to get the items listed on the ABN and still ask your health care provider to submit the bill to Medicare or another insurer. If Medicare denies payment, you can still file an appeal. However, you will have to pay for the items or services if Medicare determines that they aren't covered (and if no other insurer is responsible for payment).
For what types of services might you receive an Advance Beneficiary Notice?
A few examples of services and situation where you might get an ABN include:
- Non-emergency ambulance transportation
- Equipment and supplies, like walkers or oxygen supplies, that are from suppliers that do not contract with Medicare
- Certain types of home healthcare services
What else should you know about Advance Beneficiary Notices?
You receive an Advance Beneficiary Notice when you have Original Medicare. If you have a Medicare Advantage Plan (Medicare Part C), ask your health plan provider about what services are or are not covered.
Service providers and suppliers are not required to give you an ABN for things that Medicare never covers. Examples include long-term care (also called custodial care), routine dental care, dentures, cosmetic surgery, acupuncture, hearing aids, and exams for fitting hearing aids. In these cases you will be reponsible for costs even though you were not presented with or did not sign an ABN.
If a provider does not provide you an ABN as required, and you received service, in most cases your provider must reimburse you for the cost of the item or service.