Incomplete ABN Form

[somarco]

Client fussing because Medicare denied payment (not medically necessary) for 3 lab tests the PATIENT requested. The lab tech gave him the ABN form that listed 3 tests that MAY NOT be covered but FAILED to include the "retail" cost for each test.

Patient checked the box indicating he agreed to be responsible for payment in the even Medicare denied the claim.

Lab billed him $300 for the tests that could have been performed at a walk in lab for $140. He is blaming everyone but himself, but he (essentially) signed a blank check.



Page 4, section 6 of the attached form has this notice:

if for some reason the notifier is unable to
provide a good faith estimate of projected costs at the time of ABN delivery, the
notifier may indicate in the cost estimate area that no cost estimate is available. We
would not expect either of these last two scenarios to be routine or frequent practices,
but the beneficiary would have the option of signing the ABN and accepting liability
in these situations.


I say he is liable because he signed it, but I have never encountered this before.

What do you think?

 

[StephanieCJ]

There are some, albeit few, test and labs that Medicare either doesn't cover or doesn't cover without documentation. I would say if he signed anything accepting liability, then he learned an expensive lesson.

 

[goillini52]

Client fussing because Medicare denied payment (not medically necessary) for 3 lab tests the PATIENT requested. The lab tech gave him the ABN form that listed 3 tests that MAY NOT be covered but FAILED to include the "retail" cost for each test.

Patient checked the box indicating he agreed to be responsible for payment in the even Medicare denied the claim.

Lab billed him $300 for the tests that could have been performed at a walk in lab for $140. He is blaming everyone but himself, but he (essentially) signed a blank check.



Page 4, section 6 of the attached form has this notice:

if for some reason the notifier is unable to
provide a good faith estimate of projected costs at the time of ABN delivery, the
notifier may indicate in the cost estimate area that no cost estimate is available. We
would not expect either of these last two scenarios to be routine or frequent practices,
but the beneficiary would have the option of signing the ABN and accepting liability
in these situations.


I say he is liable because he signed it, but I have never encountered this before.

What do you think?

I got one of those and they said Medicare would only pay for one of the 4 blood tests the doctor ordered, and that's the only test I got. When I said something to the doctor he ordered the tests again and they were covered by Medicare because the 1st time, he didn't show that they were medically necessary.

 

[somarco]

I got one of those and they said Medicare would only pay for one of the 4 blood tests the doctor ordered, and that's the only test I got. When I said something to the doctor he ordered the tests again and they were covered by Medicare because the 1st time, he didn't show that they were medically necessary.

Tests are either routine/preventive or diagnostic (with symptoms or current treatment such as cholesterol that is being treated). Lipid panels can be done as often as necessary to determine the correct medication and/or dosage.

Same for A1C if diabetic or pre-diabetic.

The above are not all inclusive. Tests can be repeated for thyroid, kidney, liver, etc if there are medical issues that are being monitored.

 

[KandKsmommy]

Page 4, section 6 of the attached form has this notice:

if for some reason the notifier is unable to
provide a good faith estimate of projected costs at the time of ABN delivery, the
notifier may indicate in the cost estimate area that no cost estimate is available. We
would not expect either of these last two scenarios to be routine or frequent practices,
but the beneficiary would have the option of signing the ABN and accepting liability
in these situations.


I say he is liable because he signed it, but I have never encountered this before.

What do you think?

So crappy part is yes he is liable for those charges but he could fight that there is no reason for a lab test that they could not provide a good faith estimate. All hospitals have a charge master that indicates what the cash price is for tests.

The only time they cannot give an estimate is if it is for a service that is outsourced or if it is something like surgery or procedure that is dependent on what happens when they go under the hood (ie a colonoscopy which I have seen anywhere from $1500 to close to $10k). The lab tech did not do their job in informing the patient. That being said my local hospital is pulling this BS even without an ABN on file and I have had to report them numerous times.

 

[somarco]

there is no reason for a lab test that they could not provide a good faith estimate. All hospitals have a charge master that indicates what the cash price is for tests.

Patient requested lab work, doc agreed and wrote up the lab requisition. Labcorp was onsite at the providers office, provided paperwork, but did not fill in all the blanks. They (should) have pricing onsite.

This is the third time I have encountered a situation like this. My suspicion is, the lab is presenting a blank ABN then filling it out once the lab work is processed. Unfortunately in none of the cases did the patient ask for or receive a copy of the signed ABN . . . so no way to prove it it was blank when signed or not.

 

[alphawave2k]

My suspicion is, the lab is presenting a blank ABN then filling it out once the lab work is processed

Your suspicion on that MO by the lab could be right. Also, the folks working there won't take it upon themselves to help patients being serviced, since it's "not their job". The medical industry needs to have better pricing transparency, bottom line.