Wiki Medicare Advantage Plans

[Amanda8899]

If a provider removes a benign lesion for a Medicare Advantage patient and it is denied due to LCD guidelines do I have to write off the whole amount of the procedure since they do not recognize ABN's? What is everyone else doing? Is there such thing as a Medicare Advantage abn? Thank You!!

 

[iowagirl77]

Have you verified that the CPT and diagnosis are both correct? If they are correct but do not meet LCD, check to see if it was denied as provider responsibility or patient responsibility. I've seen where some clinics may have a form for commercial patients for services they know are never covered as proof that the patient knew it would be out-of-pocket.

 

[Amanda8899]

It was denied as provider responsibility and just does not seem fair. Atleast with Medicare we can bill the patient for some $ with an abn.

 

[m.edwards]

What type of Medicare Advantage Plan is it? UHC, BCBS, Humana?