FYI: You Trust Your Doctor, Advanced Beneficiary Notice of Non Coverage and Your Choices

[GailL1]

You trust your doctor. He prescribes a test, image or treatment but wants you to sign an ABN (Advanced Beneficiary Notice of Non Coverage) - So what is your choice on the ABN if you trust your doctor?  

I know what I do - but what do you do?

• Option 1: You want items or services that Medicare may not pay for. Your provider or supplier may ask you to pay for these items or services now, but you also want your provider or supplier to submit a claim to Medicare.

  • If Medicare denies payment: You’re responsible for paying. However, since a claim was submitted, you can appeal to Medicare.

  • If Medicare does pay: Your provider or supplier will refund any payments you made (not including your copayments or deductibles).

• Option 2: You want items or services that Medicare may not pay for, but you don’t want your provider or supplier to submit a claim to Medicare. You may be asked to pay for the items or services now. Because you asked your provider or supplier not to submit a claim to Medicare, you can’t file an appeal.

• Option 3: You don’t want the items or services that Medicare may not pay for, and you aren’t responsible for any payments. A claim isn’t submitted to Medicare, and you can’t file an appeal.

Remember, an ABN isn't an official denial of coverage by Medicare. You have the right to file an appeal if a claim is submitted and Medicare denies payment.

Medicare.gov - Your Protections

[SpringIsHereVA]

[3/1/25] @GailL1 , I had my 1st Medicare rejection payment for a test my doctor I guess said to do too early.

It was through Quest.

I am waiting to see IF I get a bill.

It was on my Medicare Account data. Not sure of official name.

I did call Quest. Very unhelpful female said it was an error on their side, something about the lab.

It is $101 and some change and will APPEAL if a BILL arrives via EMAIL. I have an ONLINE Quest account.

I ALWAYS ask IF whatever is happening is COVERED by Medicare.

Thanks for posting this info.

Take care,

Nicole  👵

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[*** @GailL1 wrote:

You trust your doctor. He prescribes a test, image or treatment but wants you to sign an ABN (Advanced Beneficiary Notice of Non Coverage) - So what is your choice on the ABN if you trust your doctor?  

I know what I do - but what do you do?

• Option 1: You want items or services that Medicare may not pay for. Your provider or supplier may ask you to pay for these items or services now, but you also want your provider or supplier to submit a claim to Medicare.

  • If Medicare denies payment: You’re responsible for paying. However, since a claim was submitted, you can appeal to Medicare.

  • If Medicare does pay: Your provider or supplier will refund any payments you made (not including your copayments or deductibles).

• Option 2: You want items or services that Medicare may not pay for, but you don’t want your provider or supplier to submit a claim to Medicare. You may be asked to pay for the items or services now. Because you asked your provider or supplier not to submit a claim to Medicare, you can’t file an appeal.

• Option 3: You don’t want the items or services that Medicare may not pay for, and you aren’t responsible for any payments. A claim isn’t submitted to Medicare, and you can’t file an appeal.

Remember, an ABN isn't an official denial of coverage by Medicare. You have the right to file an appeal if a claim is submitted and Medicare denies payment.

Medicare.gov - Your Protections ***]

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