Medterpret

Your ABN rights

When a lab hands you an Advance Beneficiary Notice (ABN), they’re telling you Medicare may not cover this test — and asking you to agree to owe the bill if Medicare denies it. You have options.

What an ABN is — in plain English

An ABN is a CMS-required form (technically: CMS-R-131). The lab uses it to shift financial risk to you. Three things are true at once:

  • The lab thinks Medicare might deny this — they’re not saying it definitely will.
  • If you sign Option 1 (“bill Medicare first”), Medicare still gets a chance to pay.
  • If Medicare denies, you owe the lab whatever they charge, which can be far more than the Medicare rate.

What that can look like

One real lab visit in February 2026, six tests: $1,068 listed on the ABN, $97 at Medicare’s rate. About eleven times the price, for the same tubes.

Founder’s own ABN. One visit, not an average.

The three options on every ABN

  • Option 1: Lab bills Medicare first. If Medicare pays, you owe nothing. If Medicare denies, you owe the lab in full.
  • Option 2:Lab doesn’t bill Medicare. You pay up front, and because Medicare never gets a claim, there is nothing to appeal.
  • Option 3:Don’t do the test. No charge — but you don’t get the bloodwork.

What we recommend

Before you sign anything, do two things:

  1. Run a Pre-Checkon your order. If your diagnosis codes don’t match Medicare’s accepted list, ask your doctor to revise before the lab visit. That eliminates the ABN in the first place.
  2. If your codes look fine but the lab still wants an ABN, call around. Many independent labs honor Medicare rates directly. Use Find a Lab to compare.

Phone script if you want to find the test elsewhere

“Hi, I have a doctor’s order for [test name]. I’m a Medicare beneficiary in [your state].”

  1. Do you accept Medicare assignment for this test?
  2. If Medicare denies, do you require an ABN?
  3. What is your cash price for this test if I want to pay up front instead?
  4. Will you put that pricing in writing before I come in?

I already signed an ABN and got billed — now what?

If you chose Option 1, Medicare was billed, so you can still appeal. You have 120 days from getting the Medicare Summary Notice to file. Appeal a denial tells you, free, what the notice says and your deadline, then drafts a letter you review, sign and send.