Advanced Beneficiary Notice

An Advanced Beneficiary Notice (ABN) is a form designed by Medicare, presented to you before receiving certain services notifying you that:

  1. Medicare may deny the procedure or service
  2. You will be responsible for the full payment if Medicare denies payment.

You have the option to receive or refuse the services.

If you sign the ABN and choose to have the services, you will be responsible for the charges. An estimate of the cost of the service will be printed on the ABN.

  • If you chose to have the services but refuse to sign the ABN, two witnesses will sign the ABN form and you will most likely be held responsible for those charges.
  • If you chose to not sign and refuse services, you would want to notify your physician of your decision.

More information about the ABN and your Medicare coverage, please contact Medicare at 800-633-4227 or