Advance Beneficiary Notice (ABN)
An Advance Beneficiary Notice (ABN) is a form required by Medicare. Belay Diagnostics gives you this notice when we believe Medicare may not pay for one or more of the tests your provider has ordered. It lets you decide, before testing, how you’d like to proceed and what you may be responsible for paying.
What you need to do
- Download and read the ABN below
- Contact us with any questions before you sign
- Choose one of the three options on the form and sign it
- Return the signed form to us before your scheduled test
Questions about this notice
If you have questions about this notice or your bill, contact us at (331) 320-0155 or contact@belaydiagnostics.com. For questions about Medicare coverage generally, call 1-800-MEDICARE (1-800-633-4227, TTY: 1-877-486-2048).
This notice reflects Medicare’s coverage rules, not a decision made by Belay Diagnostics. Signing the ABN means you’ve received and understood it; you’ll also receive a copy for your records.