Wiki ABN for Medicare Advantage Plans

[pchamp25]

Hi!

We have a patient that has a Medicare advantage plan through UHC and is going to need a Treace PEEK implant for a hammertoe correction. I know implants are not covered by Medicare and any Medicare advantage plans but we are looking into whether we could have the patient fill out an ABN form as the patient has already agreed to pay for the implant out of pocket. I am getting some conflicting information on whether we can do this or not. ABNs are used for Medicare patients but does this extend to advantage plans. If patient is agreeable to paying for the implant, do we really need an ABN form or if billing the patient for something that is not covered at all, would this be considered balance billing? Any information would be extremely helpful along w/references others have found.
TIA!

 

[ntreber]

I wold recomend contact the Medicare Advantage plan to see what their policy is.

 

[csperoni]

It is always a good idea to have the patient sign something in writing, even if not absolutely required due to never covered status. When a patient has a Medicare Advantage plan, that plan determines if and what form/notification is required for the patient. If there is no specific form required by the MA, I suggest creating something very similar to an ABN, or what you use for estimates for self pay patients.