Your Doctor wants to diagnose a condition you may have or evaluate how well your treatment is working. To do that, the doctor needs to have certain tests performed. The doctor will tell you what those tests are and why he/she thinks they are necessary.

Before a specimen is taken, you may be asked to sign an Advanced Beneficiary Notice or "ABN". The ABN was prepared by us, Medical Center Laboratory (MCL), the lab that will perform the tests. We have also prepared this brochure to answer some of the questions you might have about the ABN and why you are being asked to sign it.

NOTE:  The sample ABN is in PDF format and you will need Adobe Acrobat Reader to view. Current versions of Acrobat may be downloaded from the following site:

1. Question - What is an ABN?
Answer: An ABN is a form that lets you know that you may have to pay for a test your doctor has ordered if Medicare refuses to pay for it. Once you sign the ABN, MCL may bill you for the cost of the test if Medicare denies payment.

2. Question - Why do you want me to sign the ABN?
Answer: Although the Medicare program pays for many tests, it won't pay for some tests under certain circumstances. When that happens, MCL must ask the patient to pay. Consequently, we ask patients to sign an ABN whenever Medicare appears likely to deny payment for the specific test the doctor has ordered. The reason you are being asked to sign an ABN now is that this is one of those occasions in which we or your doctor believe Medicare won't pay.

3. Question - Why don't you think Medicare will pay for this test?
Answer: Medicare pays only for those tests that it considers to be "medically necessary". Some tests are never considered medically necessary. Some tests are always considered medically necessary. Most tests fall in the middle. They are medically necessary only under certain circumstances, depending on the patient's diagnosis. If the diagnosis the doctor lists is not one of the diagnoses Medicare will accept for that test (or if the doctor doesn't tell the lab the diagnosis) the test won't be considered medically necessary and Medicare won't pay for it. That appears to be the case with the test your doctor ordered.

4. Question - If Medicare says the test isn't medically necessary, then why perform it?
Answer: Your doctor has made a medical judgment that you need the test. When your doctor says a test is medically necessary, he/she considers your personal medical history, any medications you may be taking and generally accepted medical practices. When Medicare says a test isn't medically necessary, it's not making a medical decision about your health, it is acting like an insurance company deciding what it will and will not pay for. Just like private insurers, there are occasions when Medicare won't pay for services doctors think are important to a patient's health.

5. Question - Must I sign the ABN?
Answer: No, you have three options:

• Option One: You may sign the ABN and have the test performed.  You can be billed for the test.
  
  
• Option two: You may refuse to sign the ABN and choose not to have the test performed. However, in not having the test performed, you will be going against the medical advice of your doctor. So we advise that you consult with your doctor before choosing this option.
  
  
• Option Three: You may refuse to sign the ABN and insist on MCL performing the test. A witness will sign the ABN to indicate that you have been advised of the ABN, refused to sign it, but still want the test performed. Under Medicare guidelines, we may then directly bill you for the test.

6. Question - Will I be billed automatically?
Answer: No! We will submit a claim to Medicare. If Medicare does pay for it, you will not receive a bill. You will only get a bill if Medicare denies the claim. Remember that if Medicare denies the claim, you may contest the denial if you think it was wrong. Contact your doctor or Medicare if you want to contest a denial.

7. Question - Is Medicare more or less likely to pay if I sign?
Answer: Neither. The fact that you sign an ABN won't affect Medicare's decision either

8. Question - How much must I pay for the test?
Answer: The ABN will indicate the name of each non-covered test and the amount of each non-covered test that Medicare will not pay for. If you cannot afford to pay for the test, please discuss this with an MCL Client Billing Representative by calling (731) 265-1062 or (800) 642-1703. You may be eligible for financial assistance or consideration.

9. Question - Will supplemental insurance pay for the test if Medicare does not?
Answer: Maybe. If you have a supplemental insurance policy (like Medi-gap), contact the insurance company and ask whether the policy covers tests not covered by Medicare.

If so, find out how to submit claims for payment under the policy. MCL can not submit to supplemental carriers for you.

10. Question - Must I sign an ABN every time a new test is done?
Answer: No! You will only be asked to sign an ABN when the doctor or MCL has a good reason to think that Medicare will deny payment for the ordered test. There may be visits to your doctors office or the lab when you will be asked to sign an ABN and other visits when you won't. It all depends on the test and the reason for ordering it on that visit.

11. Question - I have never had to pay for a test before. Is this something new?
Answer: The ABN isn't new… it has been around for 10 years. However, more and more doctors and labs are using them now because of recent changes in how Medicare pays for the tests. These changes make it more likely that Medicare won't pay for a test. Since doctors and labs aren't getting paid by Medicare, they must ask the patient to pay. This explains why ABNs are becoming more common.

12. Question - You say the ABN isn't new. But I have never been asked to sign one before. Why must I sign one today?
Answer: There was no reason to believe Medicare would deny payment for the tests your doctor ordered for you during previous visits. But your doctor or we think that Medicare won't pay for the test being ordered today. Although you should ask your doctor what the difference is between today and other visits when you didn't have to sign an ABN, here are some likely possibilities:

• Your doctor ordered different tests on previous visits. This is the first time he/she is ordering this particular test.
  
• This is the same test your doctor ordered before but your diagnosis has changed - that is the doctor is ordering the test for a different reason; or
  
• This is the same test and same diagnosis, but since your last test, Medicare has changed the rules and no longer pays for the test under the diagnosis.

Medicare has denied MCL an average of nearly $20,000 per month in payment for laboratory tests which did not meet the "medical necessity" guidelines. This has forced us to use the ABN judiciously in order to stay in business.