Medicare requires your provider to notify you if a service may not be covered with an Advanced Beneficiary Notification (ABN) form. The ABN form outlines the services offered to you, and allows you to choose how Medicare will be billed. It also explains if Medicare does not cover the services billed, you will be financially responsible.
One of the most common times you can expect to receive an ABN form is when you have your annual exam. Medicare guidelines state they will cover a pelvic and breast examination as well as a screening pap smear every 24 months, unless the patient is high risk based on the Medicare criteria. If any of the high risk criteria are met, Medicare will cover the above services every 12 months.
At your next annual appointment you will be offered two or three choices depending on your age and previous cervical, uterine and breast health history.
• The first service offered is a “Women’s Wellness Visit”. If you choose to have this service, your Coastal Care team will review: health history, past medical history, family history, social history. This service is never covered by Medicare and costs $60.00 at Coastal Women’s Healthcare.
• The second service offered is a physical examination of your breast and pelvic areas. None of the services listed in the Women’s Wellness Visit will be done if you elect to only have the pelvic and breast exam.
• The third service offered will be a screening pap smear. Your provider will review with you what the guidelines are for screening and if one needs to be done.
Medicare will cover any problem-based visits. As always, we can see you at any time for problems, concerns or follow-up appointments. We strive to treat each patient as an individual and your provider will continue to work with you to provide care that meets your needs.
If you would like more information regarding Medicare coverage and guidelines please visit the Medicare website at www.medicare.gov. Should you have any additional questions, please call our office at any time to speak to a member of our Patient Care Team. We can be reached at 207-885-8400, option 5.