Medicare form ABN

[Guest KiminOrlando]

This advisory is for REGULAR MEDICARE. I have no experience with Medicare Advantage.

Be careful signing the ABN (Advanced Beneficiary Notification) form. Often if this form kicks out, it is indicating that there is a problem with the procedure or the procedure coding and Medicare is likely to deny the items listed on the form. If Medicare does not pay for the procedure, you will be paying. Pay special attention to the amount on this form. The amount they list to be paid CAN be the uninsured patient rate. It CAN be at least 10x what they would have been reimbursed if Medicare had paid. THIS IS NOT ILLEGAL. It is unethical, but Medicare cannot help you if you sign this form. I have been told you will automatically LOSE your appeal if you sign this form because it is a contract where you agreed to pay the amount listed.

If you are presented with this form, I would recommend asking for a copy of it so that you can call the Medicare number on your insurance card (from the waiting room) and give them the procedure code on the ABN form along with the state you will be receiving the procedure in (this matters). Ask them to look up the Medicare approved amount. Write down the amount. Call your ordering physician unless it is the physician you are dealing with. Go back to the people giving you the form and let them know the Medicare approved amount and ask for an explanation of the charges on the form. Ask them to explain why who pays makes that much difference (nicely). 

This just happened to me a couple of times recently. If you didn't sign the ABN, Medicare says they go to bat for you and you don't have to pay for it. I don't really know how that would work out, but I would think you wouldn't have to pay more than the Medicare approved amount. If you did sign it, you are stuck and have to pay what is on it.

I had a lymph node biopsy at a local hospital. They printed out an ABN form and wanted me to sign saying I would pay $7,198 if Medicare didn't pay. I had problems with this provider before not working claims. I called Medicare and found the most they pay is $754.00. I went back to them and they agreed to discount it to $1,798. I still said no. I called the ordering physician and they set me up elsewhere. The claim went through with no ABN being generated. This provider had left diagnosis codes off in the past, never refiled the claim and never appealed it. Then they waited for the 1 year mark to be up (appeal deadline) before they sent me a bill to let me know that they were not working the claim. They charged me the uninsured patient rate. They refused to send me the ABN form that I should have signed. Had I gone to Medicare within a year of the claim being filed, I wouldn't have had to pay the claim. I really believe some places do this because they know they can make more if the claim doesn't go through. They make no effort to fix it or work with you. 

Please be very careful when dealing with this form. Private insurances like Cigna, Blue Cross, etc. have contractual limits on what providers can charge their clients, so they are protected. Medicare has no such protections.

Please move this to the other forum if you think it belongs there. I wanted as many people to see this warning as possible.

 

[Clb75]

Thanks for the heads up. I’m sorry this happened to you, it’s a shame what some practices will do in order to get more money. Do you have any way to fight this? What about the state department of health or whoever accredits hospitals in your state? You can maybe report them for unethical billing practices. It seems that they shouldn’t be able to charge you the uninsured rate when you do in fact have insurance. 

[p8d]

Yikes!  What a mess.  I am very sorry you had to deal with this.  Thank you very much for sharing this.  I have had bad experiences with insurance companies and providers in the past but that was before I qualified for Medicare.  I will print this off and keep it because chances are good I will forget!