ABN Form Elements

An advance beneficiary notice (ABN) form can be used by insurance-participating health care providers to delineate the payment for services offered. The use of ABNs seeks to avoid the patient being “stuck” with charges for services that the patient thought would be covered by their insurance. Because the standard of care dictates that providers offer patients their health care options regardless of coverage or ability to pay, ABNs allow providers to document the health care options presented, the cost of those options to the patient and the patient’s decision regarding receiving care.

Common Elements of an ABN Form

  1. Description. ABNs often include a description of their purpose that should cover much of what the above paragraph covers: Why is this form being presented and what does the patient want to do given the necessary information?
  2. Services Offered. ABNs should identify the specific service being offered, the basis for why those services may not be covered and the cost of the services to the patient if not covered by insurance. The basis for the services not being covered can include screening, services are typically excluded and services may exceed plan benefits.
  3. Cost of Services. ABNs should clearly state the cost of services to the patient if not covered by insurance.
  4. Patient Options. ABNs typically provide the options available to patients, including receiving the services and having them billed to insurance, receiving the services and paying cash (often at a reduced price), or declining the services offered, (with risks acknowledged).
  5. Patient Decision. The execution of the ABN affirms the decision made by the patient and their financial responsibility or health risk of receiving or not receiving the recommended services.