Your ABN rights

When a lab hands you an Advance Beneficiary Notice (ABN), they’re telling you Medicare may not cover this test — and asking you to agree to owe the bill if Medicare denies it. You have options.

What an ABN is — in plain English

An ABN is a CMS-required form (technically: CMS-R-131). The lab uses it to shift financial risk to you. Three things are true at once:

• The lab thinks Medicare might deny this — they’re not saying it definitely will.
• If you sign Option 1 (“bill Medicare first”), Medicare still gets a chance to pay.
• If Medicare denies, you owe the lab whatever they charge — which can be 3–10× the Medicare rate.

The three options on every ABN

• Option 1: Lab bills Medicare first. If Medicare pays, you owe nothing. If Medicare denies, you owe the lab in full.
• Option 2:Lab doesn’t bill Medicare. You pay cash up front, and waive your right to appeal a denial.
• Option 3:Don’t do the test. No charge — but you don’t get the bloodwork.

What we recommend

Before you sign anything, do two things:

1. Run a Pre-Checkon your order. If your diagnosis codes don’t match Medicare’s accepted list, ask your doctor to revise before the lab visit. That eliminates the ABN in the first place.
2. If your codes look fine but the lab still wants an ABN, call around. Many independent labs honor Medicare rates directly. Use Find a Lab to compare.

Phone script if you want to find the test elsewhere

“Hi, I have a doctor’s order for [test name, CPT code]. I’m a Medicare beneficiary in [your state].”

1. Do you accept Medicare assignment for this test?
2. If Medicare denies, do you require an ABN?
3. What is your cash price for this test if I want to pay up front instead?
4. Will you put that pricing in writing before I come in?

I already signed an ABN and got billed — now what?

You can still appeal. Medicare gives you 120 days from the denial notice to file. Our affiliate gougestop.com walks you through the steps, deadlines, and templates.