What to do with Surprise Bills

With Medicare, "surprise bills" aren't as common as they may have been in your experience with your prior group coverage, individual coverage, etc. 

And, with Medicare, they really shouldn't even be a "surprise".  Thus we introduce you to the ABN. The Advance Beneficiary Notice, or ABN. 

Simply? The ABN warns you that if Medicare doesn't or won't pay for a certain test, you will be responsible for paying the related charge.  Short and sweet. 

You must be given this form by the provider before the test and you must sign off. If you didn't sign off and get a surprise bill?  Contact Medicare and process an appeal is our recommendation for you. 

Listen to the clip above and see the actual form below.

Observation vs Admission

Patients may receive observation care in the hospital when their doctors think they are too sick to go home but not sick enough to be admitted. They stay overnight or longer, usually in regular hospital rooms, getting some of the same services and treatment (often for the same problems) as an admitted patient — intravenous fluids, medications and other treatment, diagnostic tests and round-the-clock care they can get only in a hospital.

But observation care is considered an outpatient service under Medicare rules, like a doctor’s appointment or a lab test. Observation patients may have to pay a larger share of the hospital bill than if they were officially admitted to the hospital. Plus, they have to pick up the tab for any nursing home care.

We're posting the "fact sheet" from CMS plus an ABN (advance beneficiary notice) designed for skilled nursing facilities.  Just more and more to be aware of!  Don't assume "it's all covered; it's Medicare"