Dear Marci,
I recently went to see my doctor to receive some preventive care screenings, and wanted to get an EKG test. My doctor said that Medicare might not cover this test, and gave me something to sign called an Advance Beneficiary Notice. I’m unsure whether I should sign this notice. What is the purpose of an Advance Beneficiary Notice?
– Charles (Phoenix, AZ)
Dear Charles,
An Advance Beneficiary Notice (ABN) is a notice you should receive when a provider or supplier offers you a service or item that Medicare normally covers but may not cover for you. Know that ABNs only apply to people with Original Medicare; people with Medicare Advantage plans will not receive an ABN.
The ABN must list the reason that your doctor thinks Medicare will not cover the EKG. The notice serves as a warning that Medicare might not pay for your care; it is not an official determination from Medicare about whether or not care is covered. It may still be possible to get Medicare to cover your care if you agree to pay for it if Medicare formally denies payment.
If you receive an ABN but decide to move forward with the item or service, you must select Option 1 on the ABN form. Option 1 says you agree to pay for care in the event Medicare denies coverage. It also requires your provider to submit the bill to Medicare after providing you care. If you do not select Option 1, you will have no chance of Medicare coverage because your provider will not be required to submit the bill to Medicare.
You will know if the service is covered by checking the claim on your Medicare Summary Notice (MSN). An MSN is a summary of the health care services you have received over the past three months, and it describes whether Medicare has covered these services. If the claim is denied, you can appeal by following the directions on the MSN. If the claim is approved, the MSN will say how much you owe. If you paid the provider more than that, the provider must refund you the excess amount.
Keep in mind, by agreeing to get care and signing Option 1 on ABN, you must be willing to pay upfront for care at the time you get it and you risk being responsible for all charges if Medicare denies payment. In some cases, this can amount to a significant bill. If you receive an ABN, be sure to discuss your options for care with your provider.
– Marci