|
Linda
Brandwin, R.N.
|
 |
Linda
Brandwin
is a registered nurse and a medical billing
and claims specialist. For the past 10 years
she has worked directly with insurance companies
to give advice and guidance to the health care
consumer.
Readers may send email
or write Linda Brandwin at 5500 Single Oak Hill
Ct., Woodbridge, VA 22192.
|
ABN
form is beneficial to all parties
Dec. 5, 2003
Q:
My doctor had me sign an ABN form. What is this exactly
and why do I have to sign it?
A:
An ABN is an Advance Beneficiary Notification. There
are some services which a healthcare provider may perform
that the healthcare provider knows that Medicare may
not cover. Medicare views these services as not reasonable
or necessary for a variety of reasons. However, the
healthcare provider believes that the service is beneficial
to your health. Medicare says that the patient must
be informed in advance that Medicare may not pay for
the service and, therefore, the patient will be financially
responsible for the bill. The patient then signs an
ABN verifying that he understands this.
Medicare
believes that you need to be told ahead of time of the
possibility that Medicare will not pay on this claim
so that you can make an informed decision as to whether
you want this service or not. You must be able to make
a choice.
Medicare
will process this claim. If Medicare denies coverage
because they deem the service to be unreasonable and
not necessary and if you have signed an ABN, you will
be responsible for payment of this bill.
If
you did not sign an ABN and Medicare denies coverage,
then you will not be responsible for the bill. The health
care provider may not bill you for this service. He
has to write it off. You needed that advance notification
and the health care provider neglected to give it to
you.
An
ABN actually protects you and the healthcare provider.
You and your healthcare provider discuss the necessity
of this particular service. You decide if you want the
service and if you are willing to pay for it. If the
healthcare provider performs this service, he will know
that he will be reimbursed. The ABN is beneficial to
all parties.
|
