Transcription of Advance Beneficiary Notice of Noncoverage (ABN)
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Advance Beneficiary Notice of Noncoverage (ABN)
A. A. Notifier: Animas Anesthesia Associates, LLC, PO Box 4860, Murrells Inlet, SC 29576 (toll free) B. Patient Name: C. Identification Number: Advance Beneficiary Notice of Noncoverage (ABN) NOTE: If Medicare doesn t pay for D. below, you may have to pay. Medicare does not pay for everything, even some care that you or your health care provider have good reason to think you need. We expect Medicare may not pay for the D. below. D. E. Reason Medicare May Not Pay: F. Estimated Cost Anesthesia for endoscopic procedure Medicare may not consider this service to be medically necessary $ WHAT YOU NEED TO DO NOW: Read this Notice , so you can make an informed decision about your care.
A. A. Notifier: Animas Anesthesia Associates, LLC, PO Box 4860, Murrells Inlet, SC 29576 888.819.7818 (toll free) B. Patient Name: C. Identification Number:
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