Why would anyone not always choose option 3 on the ABN?

Mar 6, 2019

  1. secondcreek
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    secondcreek Super Genius

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    My wife is on a Plan F and received her first Advance Beneficiary Notice of Noncoverage (ABN). She is starting physical therapy this afternoon. What am I missing? Why wouldn't you always go with option 3?

    When I searched Medicare.gov for physical therapy the only thing I found is that they removed the limit for 2019.

    Option 1: I want the D. Financial Responsibility but bill Medicare for an official decision on payment

    Option 2: I want D. Financial Responsibility but do not bill Medicare. I cannot appeal if Medicare is not billed.

    Option 3: I don't want the D. Financial Responsibility. I understand with this choice I am not responsible for payment and I cannot appeal to see if Medicare would pay.
     
  2. ICACharleston
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    ICACharleston Expert

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    If you use option 3, while you don’t get billed you don’t get treated either. Lookup ABN instructions on the CMS site for details.
     
  3. LostDollar
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    LostDollar Guru

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    Nice reminder how that works. Thanks.
     
  4. somarco
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    somarco That Medicare Expert Guy

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    Checking option 3 means the beneficiary does not want the test, treatment, etc. If the provider performs the test, etc. the provider is acknowledging they MAY not be paid.

    How many providers do you think will go ahead with the test or procedure knowing they may not be paid?
     
    somarco, Mar 6, 2019
    #4
  5. LostDollar
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    LostDollar Guru

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    (Those who are REALLY concerned about whether or not the person has/or may get cancer? :D)
     
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