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What is an ABN?

The Advance Beneficiary Notice (ABN) is a form that explains what Medicare won’t pay for, the reasons why Medicare won’t pay, and also gives an estimate of costs. The ABN helps to give you enough information to make an informed choice about whether or not to get the care, knowing that you or your other insurer may have to pay for it.

Fort HealthCare provides Advanced Beneficiary Notice to Medicare beneficiaries.

To comply with state and federal laws, Fort HealthCare provides an Advanced Beneficiary Notice (ABN) to Medicare patients before providing services if we know, or should know, that a service may be considered not reasonable or necessary according to Medicare coverage plans.

Fort HealthCare will inform Medicare beneficiaries that an item or service may not be deemed medically necessary by Medicare, and therefore, the beneficiary will be responsible for payment.

Examples of situations for which an ABN would be necessary:

  • A patient comes in for a Pap smear and doesn’t know when that last one was done. An ABN is needed because Medicare pays for screening Pap smears once every 2 years unless high risk factors are present. There is a frequency limitation on this service.
  • A patient comes in for a screening mammogram nine months after the last one was performed. An ABN is needed because Medicare only pays for a screening mammography once every year. There is a frequency limitation on this service.
  • The service provided is for screening purposes.
  • A patient asks for a test or injection that is covered by Medicare for some diagnoses but not the one the patient exhibits.
  • A patient requests more injections, treatments, etc. than Medicare will cover.

View the official Medicare Services site here.