Helping you understand your laboratory costs

PCL Alverno provides patients with an Advanced Beneficiary Notice (ABN) when the health care provider believes that Medicare may not pay for an item or service that Medicare usually covers because it is not considered medically reasonable and necessary for this patient in this instance.

PCL Alverno is dedicated to helping their patients be healthy and informed. Information is a powerful tool on your journey to optimal health. As a professional courtesy to their existing and potential new patients, PCL Alverno shares important information regarding Medicare and the insurance coverage of tests you have performed at a PCL Alverno laboratory.

Medicare’s annual open enrollment period begins October 15, 2018 and runs through December 7, 2018 for 2019 coverage. During this timeframe, new members can join Medicare and existing members can modify their current coverage. We look at this as a perfect time to make everyone aware of Advanced Beneficiary Notices (ABN), what they mean, why they are issued, and how you can help understand your potential lab costs.

Let’s begin at the beginning – your healthcare provider orders a lab test. There are several reasons why your healthcare provider may have ordered the test. It could be a regular part of your maintenance for a health issue, included in a wellness exam, or a diagnostic test to determine if you have a medical condition.

Second step — your provider’s office should review Medicare guidelines to determine if your test meets Medicare’s requirements for medical necessity. We encourage you to ask your physician office if they have checked. Medicare Part B covers medically necessary clinical diagnostic laboratory tests and covers specific preventative services to prevent or manage a condition.

In some cases, Medicare has defined periodic frequencies for a test. For example, Medicare may cover a specific blood test once per year. If your healthcare provider wants you to have that blood test every six months, Medicare will not cover the second test and you would be financially responsible.

If coverage is expected to be denied, as in the case of the second blood test example above, the laboratory must provide you with an Advanced Beneficiary Notice, or ABN. Providers are required to provide patients with an ABN before tests are conducted so they understand they may be financially responsible for the cost of the test. PCL Alverno provides patients with an ABN in these circumstances.

PCL Alverno partners with physicians, hospitals, and clinics to conduct testing that will detect disease in symptomatic as well as asymptomatic patients. Accurate testing is critical for all patients. Healthcare providers need a plan for the timely testing of illness and disease to determine the proper course of action.

Alverno uses the most up-to-date technology to help identify disease causing agents as quickly as possible. Trained Laboratorians test samples, record data, and provide accurate results. Over 30 hospitals in Indiana, Illinois – including Chicago and its suburbs, trust PCL Alverno to deliver accurate test results in a timely manner.