My question involves insurance law for the state of: New York
If a patient signs the above (ABN) and the secondary insurance denies the claim because Medicare didn't pay anything, can the patient be held responsible for the charge?
My question involves insurance law for the state of: New York
If a patient signs the above (ABN) and the secondary insurance denies the claim because Medicare didn't pay anything, can the patient be held responsible for the charge?
Assuming that what the patient signed was the Form CMS-R-131, which is the form Medicare provides for the ABN, then it matters exactly how the form was completed. The form is pretty much self-explanatory, I think. The key is which option the Medicare beneficary checked in block G. If the beneficiary took option 3, that option specifically states that beneficiary does not want the service listed in D and is not responsible for payment if that service is provided. With Option 2, the beneficiary agrees to pay and not have the provider bill Medicare. With Option 1, the provider bills Medicare and if Medicare does pay then the beneficiary is only obligated to pay the co-pays or deductible; if Medicare does not pay then the patient is responsible for payment.