What is an ABN — and what should you do when the lab hands you one?

If you’ve ever had a lab front desk hand you a one-page form titled Advance Beneficiary Notice of Noncoverage and ask you to sign, you’ve met the ABN. Officially it’s CMS form CMS-R-131. Practically, it’s a hot-potato.

What the ABN really says

Three things are true at once on every ABN:

• The lab thinks Medicare might deny this — they’re not certain.
• By signing, you agree that if Medicare denies, you owe the lab.
• The lab’s billed price (what you’d owe) is often 3–10× the Medicare-allowed rate for the same test — rates Medicare publishes in its Clinical Laboratory Fee Schedule.

The three options

1. Bill Medicare first. If Medicare pays, you owe nothing. If they deny, you owe the lab in full.
2. Skip Medicare, pay cash now — and waive your right to appeal.
3. Don’t do the test. No charge. No bloodwork.

What we recommend

Don’t sign at the counter. Step out, run Pre-Check on your phone, and verify whether the diagnosis codes on your order are even on Medicare’s accepted list. If they’re not, ask your doctor to revise — that solves it before the test happens.

For more detail, see Your ABN Rights or the Center for Medicare Advocacy’s ABN guide.

If you’ve already signed and gotten a bill

Different territory — you’re past the prevention window and into recovery. GougeStop, a Medterpret tool, works from a photo of the bill itself and walks you through the bill comparison and negotiation; for a denial, start with Appeal a denial. See also 5 Things to Do Before You Pay a Lab Bill.

Sources

1. CMS — Beneficiary Notices Initiative (ABN Form CMS-R-131)
2. CMS — Clinical Laboratory Fee Schedule
3. Center for Medicare Advocacy — Advance Beneficiary Notices (ABNs)