Am I protected from having to pay if I did not receive an ABN?

September 20, 2009 by admin

Generally, yes, you are protected. If a physician, provider, or supplier fails to give you an ABN, or gives you a defective ABN, you probably 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 proof that, before the services or items were furnished to you, you knew or should have known that Medicare would not pay, then you may be held liable for payment. The most likely case in which this could happen is if you received the same (or closely similar) 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 apply to claims that are not assigned; in those claims, you must receive an ABN and sign it or else you are protected.