The form you are being asked to sign is called an Advance Beneficiary Notice (ABN). Medical providers are required to give you an ABN if they know or have reason to believe that Medicare will determine the service to be not medically necessary for you, and so, will not pay.
Ask your doctor why you need to sign this form if he believes you need the services he is giving you. Medicare should pay for most medical services you need except services specifically excluded from coverage.
For more information about what Medicare does not cover, click on the link in the GO TO box.
If the doctor believes you need the services but that Medicare will not pay for them, ask him to write Medicare a letter justifying your need.
If the doctor will not write Medicare a letter justifying the need for services, you may want to find another doctor and not sign the form.
If you sign an ABN, you may be responsible for all charges.
In limited circumstances, you can ask Medicare to tell you whether or not the service will be covered for you before you get it (prior determination). You can only do this when you receive an ABN for certain very expensive, non-urgent services.
To learn more about when you can ask for prior determination, click on “Can I ever find out before I get a service whether Medicare will pay?” in the GO TO box.
Even after you receive the service for which you signed the ABN, you should still ask your doctor to submit a claim to Medicare. If the doctor explains why the service is necessary, Medicare may pay. It should pay for most reasonable and necessary services.
For more information about a particular claim, go to the LINKS box or call 1-800-MEDICARE to contact your Medicare Part B carrier.
To learn more about Advance Beneficiary Notices, click on the link in the GO TO box.