Our Medicare provider and or health plan have determined that Medicare probably will not pay 2025

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you can file an appeal. Before you start an appeal, you can ask your provider or supplier for any information to make your appeal stronger. If youre in a Medicare Advantage plan, other health plan, or a drug plan, check your plan materials, or contact your plan, for details about your appeal rights.
A refusal to bill Medicare at your expense is often considered Medicare fraud and should be reported. To report fraud, contact 1-800-MEDICARE, the Senior Medicare Patrol (SMP) Resource Center (877-808-2468), or the Inspector Generals fraud hotline at 800-HHS-TIPS.
Youre eligible for Part A at no cost at age 65 if 1 of the following applies: You receive or are eligible to receive benefits from Social Security or the Railroad Retirement Board (RRB). Your spouse (living or deceased, including a divorced spouse) receives or is eligible to receive Social Security or RRB benefits.
Inform Patient of Potential Financial Responsibility If a Medicare patient wishes to receive services that may not be considered medically reasonable and necessary, or you feel Medicare may deny the service for another reason, you should obtain the patients signature on an Advance Beneficiary Notice (ABN).
An advance written notice of non-coverage helps Medicare Fee-for-Service (FFS) patients choose whether to get items and services Medicare usually covers but may not pay for because theyre not medically necessary or are considered custodial care.
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An Advance Beneficiary Notice (ABN), also known as a Waiver of Liability, is a notice a provider should give you before you receive a service if, based on Medicare coverage rules, your provider has reason to believe Medicare will not pay for the service. You may receive an ABN if you have Original Medicare.

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