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
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
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
you have questions, or for more information about
your Medicare coverage, please contact the
Medicare Beneficiary office at the following numbers
What’s an ABN Form?
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
The ABN form states that Medicare will probably deny
payment for the test or service.
The ABN form also tells you the reason we expect
Medicare to deny payment.
The estimated cost for the test or service is on the
You will select one of 3 options and sign the ABN
Do I have to sign the ABN?
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
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?
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.