I signed an ABN at the doctor's office. Does that mean I have to pay?
Last reviewed 2026-07-31
An ABN is a warning, not a bill and not a Medicare decision. It says the provider thinks Medicare may not pay for one item. Signing it can shift the cost to you, but Medicare still rules on the claim if you ask for it to be billed, and that ruling can be appealed.
What happened
Before a test or a visit, the office handed you a form. It said Medicare may not pay for one item. It asked you to pick a box and sign. Staff may have been in a hurry. That form is an ABN.
What usually applies
An ABN is a warning from the provider. It is their opinion, not a Medicare ruling. The form lists three boxes. The office may not pick one for you. Box 1 means you want the care and you want Medicare billed. Medicare then rules on the claim in writing. If Medicare says no, that notice shows how to appeal. Box 2 means you want the care with no bill to Medicare. Then there is no appeal. Box 3 turns the care down.
“The ABN is issued in order to transfer potential financial liability to the Medicare beneficiary in certain instances.”
“This notice gives our opinion, not an official Medicare decision.”
“G. OPTIONS: Check only one box. We cannot choose a box for you.”
“OPTION 1. I want the D. listed above. You may ask to be paid now, but I also want Medicare billed for an official decision on payment, which is sent to me on a Medicare Summary Notice (MSN). I understand that if Medicare doesn’t pay, I am responsible for payment, but I can appeal to Medicare by following the directions on the MSN.”
“OPTION 2. I want the D. listed above, but do not bill Medicare. You may ask to be paid now as I am responsible for payment. I cannot appeal if Medicare is not billed.”
What to do
- 1
Get a copy of the form you signed
The office must give you a copy. Look at which box is marked and what item the form names.
- 2
Check that the form gives a reason
The form must name the item and say why Medicare may not pay. A blank reason is worth a question.
- 3
Ask the office to bill Medicare anyway
Box 1 asks them to send the claim in. That gets you a written ruling you can appeal.
- 4
Watch for your Medicare Summary Notice
It comes about every three months. It shows what was paid or denied, and how to appeal.
Ask for help if the form was blank, or if you signed after the care was done. Call 1-800-MEDICARE with the form in hand. Your State Health Insurance Assistance Program, or SHIP, gives free help with this.
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Sources
- Centers for Medicare & Medicaid Services, FFS ABN (cms.gov)Retrieved 2026-07-31
- CMS, Form CMS-R-131 Advance Beneficiary Notice of Noncoverage, via reginfo.govRetrieved 2026-07-31
Last reviewed 2026-07-31