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1400 West Main Street
Bellevue, Ohio 44811
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Advanced Beneficiary Notice

Advanced Beneficiary Notice (ABN)
Medicare and Outpatient Testing

Dear Medicare Patient, 

Medicare may not pay for certain services, tests or procedures even if your doctor has ordered the test. 

Medicare requires your doctor to list a diagnosis or medical problem when ordering a test. Medicare will pay only for tests and procedures considered “medically necessary” based on the diagnosis listed. 

Before a test is done, you may be asked to sign an Advanced Beneficiary Notice (ABN) form if we believe Medicare probably will not pay for the test or procedure.

If you have questions, or for   more information about your Medicare coverage, please contact the Medicare Beneficiary office at the following numbers and website: 

TTY: 877.486.2048  

What’s an ABN Form? 

1. An ABN form lets you know, before you receive a service, you will have to pay for a test or procedure your doctor ordered if Medicare doesn’t pay. 

2. The ABN form states that Medicare will probably deny payment for the test or service. 

3. The ABN form also tells you the reason we expect Medicare to deny payment. 

4. The estimated cost for the test or service is on the ABN form. 

5. You will select one of 3 options and sign the ABN form. 

Do I have to sign the ABN? 

NO.    You have 3 options. 

Sign the ABN, have the test, and be billed for the test if Medicare doesn’t pay. 

Refuse to sign the ABN, have the test, Medicare will not be billed, and you will pay the hospital. 

Sign, or refuse to sign, the ABN and do not have the test. Please call your doctor to discuss your future treatment plan.

Does it mean I don’t need the test, if Medicare won’t pay for it?
  Your doctor makes decisions about your medical care on a wide range of factors. Even if your doctor feels a particular test is medically appropriate, Medicare may not consider the test medically necessary for patients with your medical condition. Please discuss your options with your doctor.

Will supplemental insurance pay for the test if Medicare doesn’t?
Probably not.
Usually supplemental insurance policies (“Medigap”) do not reimburse for testing not paid for by Medicare. You may contact your insurance company and ask if your policy covers tests and procedures not covered by Medicare.

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