I SUPPOSE YOU’VE heard that the Social Security/Supplemental Security Income [SSI] COLA for 2019 will be 2.8 percent, right?
And that they haven’t figured out the 2019 Medicare rates, right?
So, we’re containing our enthusiasm, right?
OK, just checking.
Now …
This is interesting; well, it’s interesting if you’re on Medicare or are associated with someone on Medicare.
If neither of those things is true, this might be about as interesting as the first 22 pages of your cellphone contract.
But we’re going to assume that you are on Medicare, so you’re probably all atwitter already.
Here we go.
Recently a buddy of mine, who happens to be a very sharp lady who understands more than a little bit about Medicare, was at a local hospital for a medical issue.
As she was leaving, she was asked to sign a blank “ABN” form which seems, if you’re in the Medicare game … odd.
Let’s back up.
ABN stands for Advance Beneficiary Notice of Noncoverage — feel smarter? I know.
An Advance Beneficiary Notice of Noncoverage is something you might get from your doctor, any health care provider or even supplier (think, durable medical equipment, if: (a) you are on original Medicare not on a Part C Medicare Advantage Plan; which means, almost all of us around these parts), and (b) said health care provider thinks Medicare probably or certainly won’t pay for some or all of any of the services or items you received).
The ABN is supposed to list, in detail, (a) the services or items that Medicare isn’t expected to pay for, (b) an estimate of the costs for said services or items, and (c) the reasons why Medicare might not pay.
The form asks you to choose an option box and sign the notice, signifying that you’ve read and (presumably) understood it.
Here are the options you can choose from:
• You want the services or items that might not be paid for by Medicare. Your provider could ask you to pay for them right then, but you want them to submit a claim to Medicare to see what happens. If the claim is denied, you could appeal it.
• You want the services or items that might not be paid for by Medicare, but you don’t want your provider to submit a Medicare claim. You might or might not be asked to pay at that time, but there will be no Medicare appeal rights because no claim was submitted.
• You do not want the services or items in question. Period. So, no cost, no claim, no appeal.
So, that’s straightforward enough, huh?
It is considering that we’re talking about Medicare; but here’s the point that comes up for me: As noted above, the ABN is supposed to list exactly what services or items we’re talking about, an estimate of the cost for same and why Medicare isn’t expected to pay.
So, if you’re being asked to sign a blank ABN form, none of that info is there, right?
What am I missing?
It could well be that these Medicare-ain’t-gonna-pay services or items were discussed with my buddy, the patient. Good.
As it should be, but I don’t think that would obviate the responsibility to have them detailed on the ABN form.
Besides we all know that we often miss a lot of what health care providers say to us anyway, so I’d want it in writing.
And, who knows? I might even want to give it some thought.
Do I think that this was an attempt to commit Medicare fraud?
Absolutely not.
I’d be willing to bet you your unreimbursed Medicare costs that it was a mistake, a misunderstanding on a staff person’s part or (at worst) shoddy work.
But the outcome is the same:
The Medicare patient is being asked (and, probably, feeling compelled) to sign a blank form that says, “I’ll pay for whatever Medicare doesn’t.”
I think that’s contraindicated.
Now, perhaps the provider in question (or someone else) will enlighten me as to what circumstances might warrant asking a patient to sign a blank ABN form, then I’ll be enlightened.
Unless or until that occurs, I’d be inclined to recommend against any of us signing said blank form.
In fact, I’m not a big fan of signing any blank form Medicare-related or not.
Why would I do that? Because I just love surprises?
Many of us are familiar with the phrase, “Don’t sweat the small stuff.”
Allow me to observe that Al Capone was busted for income tax evasion — sweat the small stuff.
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Mark Harvey is director of Clallam/Jefferson Senior Information & Assistance, which operates through the Olympic Area Agency on Aging. He is also a member of the Community Advocates for Rural Elders partnership. He can be reached at 360-452-3221 (Port Angeles-Sequim), 360-385-2552 (Jefferson County) or 360-374-9496 (West End), or by emailing harvemb@dshs.wa.gov.
