How an Advanced Beneficiary Notice Protects You

Know your billing rights

Advanced Beneficiary Notice ABN
You may be able to tear up your bill if you did not sign an Advanced Beneficiary Notice (ABN). Michael Krinke/E+/Getty Images

Do not necessarily jump to paying that medical bill. If you are on Original Medicare (Part A and Part B), you may not be liable for all charges.

How Much You Are Expected to Pay

When you go to the doctor's office, you have a right to know what you will pay. Original Medicare pays 80 percent of your Part B costs. This leaves you to foot the 20 percent difference. The exceptions to this 80-20 rule are Annual Wellness Visits and preventive screening tests (bone density studies, colonoscopies, mammograms, Pap smears, prostate cancer screening, etc.) which will be free to you as long as your doctor accepts assignment.

Keep in mind you must also be an appropriate candidate for those screening tests.

What Happens When Medicare Won't Pay

Unless Medicare sees the ordered test as medically necessary, they won't pay for it. Many doctors will bill you for what Medicare does not pay. This leaves you paying not just your expected 20 percent but the full dollar amount.

Each time your healthcare provider orders a test or performs a procedure, he is obligated to tell you if the test may not be covered by Original Medicare. This is not simply an issue of being fair. It is the law.

Using The Advanced Beneficiary Notice

This is when the Advanced Beneficiary Notice (ABN) comes into play. This is a form you will be asked to sign whenever your doctor orders tests that are not a standard part of the office visit. This may include lab work, EKGs, imaging studies, biopsies and other tests.

The ABN must be completed at each visit and must clearly notify you how much the test would cost you if Medicare did not cover it.

If you were not offered this form to sign, you were not given the opportunity to decline treatment.

The Centers for Medicare and Medicaid Services clearly states you are not liable to pay the 80 percent that Medicare does not pay in this case. You will still be required to pay the 20 percent amount that you would have otherwise paid.

Please know if you choose not to sign an ABN, the doctor's office is not required to provide the services listed on the form.

What to Do When You Get a Bill 

Before paying your bill, you may want to do some investigation. It may take time but could save you money.

The first thing to do is contact your doctor's office or their billing office. It could be that Medicare declined coverage for a test because the wrong billing code was used. If your doctor changes the code to a more appropriate one, Medicare may change their decision.

Once the billing code issue has been addressed, it could be that Medicare still refuses coverage. You may want to contact your doctor's office to see if you signed an ABN for that test on that day. If you did not sign one and you are on Original Medicare, you are not responsible for paying more than your 20 percent coinsurance for that specific test. Your doctor's office cannot charge you for the remaining 80 percent. The ABN does not apply to people on Medicare Advantage plans.

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