The Medicare advance beneficiary notice of noncoverage form is completed by a physician or other health care provider to notify a patient that the expense of a proposed service or procedure is not likely to be paid by the Medicare program. The patient's portion of the form is used to record the patient's choice to proceed with the proposed service or not and which financial options the patient prefers, according to Medicare.gov.Continue Reading
Health care providers such as laboratories, home health agencies and other medical suppliers complete the first part of the advance beneficiary notice of noncoverage form, according to the Centers for Medicare & Medicaid Services. The provider lists the proposed service, test, procedure, care or equipment; the reason Medicare may not pay, such as an experimental procedure that is not covered; and the estimated cost of the procedure.
The patient chooses from three options and then signs the form, says the Centers for Medicare & Medicaid Services. The patient can choose to proceed with the proposed service and request that the provider bill officially Medicare anyway, assuming responsibility for costs if Medicare declines. A second option is to proceed with the service with the patient agreeing to pay for the cost themselves. The third choice is to decline the proposed service altogether.Learn more about Health Insurance