A Medicare waiver, also known as an ABN, or Advance Beneficiary Notice, is a document received before treatment services or equipment are given. The waiver is to notify the Medicare-covered patient of possible non-coverage. In effect, it states that the patient has be made aware of the fact that the services or medical devices requested may not be covered under the patient’s Medicare plan. In that event, the patient is responsible to pay any expenses incurred during the treatment or for the equipment purchased.
Medicare is broken down into parts. Each part, A, B and D, covers different things. For example, part A generally covers things like hospitalization, skilled nursing facilities and hospice care. Part B generally covers medically necessary physician services, preventative care and some medical equipment. Part D provides optional prescriptions coverage. But just because you have the Medicare insurance plan to cover the expected treatment course does not mean it will be covered fully.
On occasion, services or equipment deemed medically necessary by your healthcare provider may not be covered. Many alternative medical practices and vision care are examples of medically relevant treatments that are not covered by Medicare. Other times, Medicare may cover the expenses with limitations. For example, some services are only covered a certain number of times within a certain time frame. This is where the Medicare waiver comes into play.
A Medicare waiver does not mean the patient is being refused treatment or equipment. It also does not mean the treatment is not medically necessary. It simply means that the expenses incurred may be higher than the patient’s normal Medicare co-pay, as Medicare typically does not cover 100 percent of the costs.
The Medicare waiver gives the patient the right to accept the possibility that the expenses incurred may be out-of-pocket. It also gives you the right to refuse the treatment or equipment. Though given a Medicare waiver does not mean there is no possibility of getting the services or equipment covered as the patient is offered the right to appeal the decision of non-payment.
If a patient receives a Medicare waiver, or ABN, the first step is to contact the physician prescribing the service or device to be used. There may be some alternatives to consider. The physician can also play an important role in the appeal process to prove the treatment course is medically relevant and can assist the patient in recovery from a specific ailment or illness.
