Notificación previa para beneficiarios de no cobertura

Usted puede recibir una notificación por escrito denominada "Aviso anticipado de no cobertura para el beneficiario" (ABN) de su médico, otro 

proveedor de cuidado de salud

o proveedor si usted tiene 

Medicare original

 y su médico, proveedor de salud u otro proveedor piensa que Medicare probablemente (o con certeza) no pagará los artículos o servicios recibidos por usted. 

Sin embargo, un ABN no es necesario para los artículos o servicios que Medicare no cubre jamás.

La ABN enumera los artículos o servicios que no se espera que corran por cuenta de Medicare, una estimación de los costos de los artículos o servicios y los motivos por los que es posible que Medicare no pague.

 

Se le solicitará que seleccione un cuadro de opción y que firme la notificación para indicar que la ha leído y comprendido. Debe seleccionar una de las siguientes opciones:

  • Option 1: You want the items or services that may not be paid for by Medicare. Your provider or supplier may ask you to pay for them now, but you also want them to submit a claim to Medicare for the items or services. If Medicare denies payment, you’re responsible for paying, but, since a claim was submitted, you can appeal to Medicare. If Medicare does pay, the provider or supplier will refund any payments you made (minus the copayments and deductibles you paid).
  • Option 2: You want the items or services that may not be paid for by Medicare, but you don’t want your provider or supplier to bill Medicare. You may be asked to pay for the items or services now, but because you ask your provider or supplier to not submit a claim to Medicare, you can’t file an appeal.
  • Option 3: You don’t want the items or services that may not be paid for by Medicare, and you aren’t responsible for any payments. A claim isn’t submitted to Medicare, and you can’t file an appeal.

An ABN isn't an official denial of coverage by Medicare. You have the right to file an appeal if Medicare denies payment when a claim is submitted.

¿Cuáles son los otros tipos de ABN?

Otros tipos de ABN incluyen:

  • "Skilled Nursing Facility Advance Beneficiary Notice" (SNFABN): A skilled nursing facility (SNF) will issue you a SNFABN if there's a reason to believe that Part A may not cover or continue to cover your care or stay because it isn't reasonable or necessary, or is considered custodial care [glossary] . The SNFABN lets you know that Medicare will likely no longer pay for your services. If you choose to get the services that Medicare may not cover, you don't have to pay for these services until a claim is submitted and Medicare officially denies payment. However, while the claim is processed, you have to continue paying costs that you would normally have to pay, like the daily coinsurance and costs for services and supplies Medicare generally doesn't cover.
  • "Hospital Issued Notice of Noncoverage" (HINN): Hospitals use a HINN when Medicare may not cover all or part of your Part A inpatient hospital care. This notice will tell you why the hospital thinks Medicare won't pay, and what you may have to pay if you keep getting these services.

nota:

You may get an Advance Beneficiary Notice of  Noncoverage if you're getting an off-the-shelf back or knee brace that's included in the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program from a supplier that isn't a competitive bidding contract supplier.

 

Sepa a quién llamar sobre las opciones de Medicare, reclamaciones y más.