Advance Beneficiary Notice

A limited number of non-emergency outpatient tests are not covered by the Medicare Program. If your physician orders a non-covered test, you will be asked to sign an Advance Beneficiary Notice (ABN) agreeing to accept financial responsibility for the non-covered test.

If you refuse to sign the ABN, the test will not be performed. It is important for you to consult with your physician before making this decision. Only your physician knows your individual history and can determine the tests that are needed to properly diagnose and treat you. Medicare does not know you or your needs, but is simply acting as an insurance company in determining the services it will cover as "medically necessary."

In some cases, Medicare may deny payment for a test that was previously covered. For example:

• Although this is the same test, the physician is ordering the test for a different reason, or
• This is the same test and same diagnosis; however, Medicare has changed the rules since your last visit and will no longer pay for this test with this diagnosis.

Even though the hospital expects payment to be denied, the hospital is required to bill Medicare for the service. If Medicare pays for the test, you will only be responsible to pay for any deductible or co-insurance. If Medicare denies the claim, you will be responsible to pay the bill.

You have the right to appeal Medicare's decision. If you have supplemental insurance, you should contact the insurance company directly to see if the test is covered since each benefit plan is different. Please call one of our customer service representatives at 909.980.9511 to answer any questions you may have about our billing and payment policies.