# ABN for Medicare Advantage Plans



## Lorisvg (Dec 30, 2014)

I am hoping that someone can tell me how they are dealing with this problem.
We have been told by Network, UHC and Anthem that we can not use an ABN for their Medicare patients before a service is rendered without first getting a "predetermination". We are a Family Practice office in Wisconsin, and we do a bit of everything, which makes this extra difficult to implement.

The predetermination is supposed to be for anything we _feel_ may not be covered. Then if the insurance says "no, we won't cover it", we can have the patient sign a form saying they will be responsible for the payment.
Each different Medicare plan within each insurance company is different, so it is almost impossible to know who covers what, and for which diagnosis.

If we know something won't be covered- then they say we don't need a predetermination, or a signature, and the patient would be liable. I feel this scenario is an open pit waiting for us to fall in to it. 

Our biggest problems seem to be figuring out how to make this do-able for the staff without tying up much of their time, the gray area of what we "feel" might not be covered, and not having to write off services. Is anyone else having this problem?


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## bonn715 (Jan 24, 2015)

my understanding of the ABNs is exactly what you put if it is a service that is covered under certain circumstances but probably not for what you are doing it for, you get the ABN.
Replacements follow Medicare regulations, so I would think the same services you would get them for Medicare you would get them for the replacements, but it is always best to check the payor.

for Anthem, i just typed in the subject line "what services does anthem replacement plan require ABN for" and the link that came up was explaining to their members in Medicare terms, so if they want them for anything else, there is nothing wrong with asking the payor for a list of what codes they need ABN for aside from what Medicare lists and see what they say

https://www.anthem.com/ca/health-in...t-is-advance-beneficiary-notice-for-medicare/


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