Medicare & Non-Covered Services Frequently Asked questions
If Medicare will not pay for a service, does that mean that I do not need the service?
What is "Medical Necessity"?
What is an ABN?
What options do I have?
What are my rights as a patient?
What if I decline to sign the ABN?
How does the billing process work?
If Medicare will not pay for a service, does that mean that I do not need the service?
No. Your doctor bases decisions on a wide range of factors including your personal medical history, any medications you might be taking, and generally accepted medical practices.
Even if your doctor believes a particular test or service is appropriate for you, it is possible Medicare may not consider the service to be medically necessary for patients with your diagnosis.
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What is "Medical Necessity"?
Medicare covers only those services which are reasonable and necessary for your treatment.
Medicare requires all providers to report information regarding the patient's diagnosis when seeking payment in order to determine whether the services ordered were medically necessary.
What is an ABN?
An ABN is an Advance Beneficiary Notice. The purpose of the ABN is to give you advance notice that Medicare may not pay for your services.
The ABN tells you which test(s) are not reasonable and necessary and informs you that you will be financially responsible for the services. When it is required, you will be asked to sign the ABN before services are performed.
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What options do I have?
You have two options when an ABN form is presented to you.
You may:
- Agree to be responsible for payment of services that Medicare does not consider reasonable and necessary and receive the services or,
- Refuse to be responsible for payment of services that Medicare will not cover and, therefore, not receive the tests or services.
What are my rights as a patient?
As a Medicare beneficiary, you have certain guaranteed rights. These rights protect you when you receive health care; assure you access to needed health care services; and protect you against unethical practices.
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What if I decline to sign the ABN?
If you demand the service(s) and decline to sign the ABN, the services will be performed and you will be responsible for payment.
How does the billing process work?
Generally, your doctor will bill Medicare when you receive a service at his/her office.
However, when your doctor orders testing from a facility or laboratory outside of his or her office, the facility performs the tests which were requested and the facility, not your doctor, bills Medicare directly for the tests being performed for you. The facility provides Medicare with your Medicare number, the tests performed, and your diagnosis provided by your doctor.
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Ball Memorial Hospital Patient Financial Services
2401 University Ave.
Muncie, IN 47303
(765) 747-3068
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