Are you protected from having to pay if you did not receive an ABN?
Are you protected from having to pay if you did not receive an Advance Beneficiary Notice (ABN) or is there something wrong with the ABN that you received?
In general, you are protected. If a physician, provider, or supplier fails to give you an ABN, or gives you a defective ABN, you almost certainly will be protected from financial liability for the cost of the service or item. However, with respect to services and items for which your supplier, physician, or provider takes assignment of your Medicare claim, if there is any other evidence that, before the services or items were furnished to you, you knew or should have known that Medicare would not pay, then you can be held responsible for payment. The most likely situation in which this could take place is if you received the same (or closely alike) services or items previously and you received a Medicare denial of payment for them. In such a case, the earlier denial from Medicare can be considered as “notice” to you that Medicare will not pay. This does not relate to claims that are not assigned; in those claims, you should receive an ABN and sign it or else you are protected.
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