Whenever a patient is about to receive any type of J - code medication via injection, including Avastin, Lucentis, Eylea, Gancyclovir, Ozurdex, etc., the patient must be provided an ABN (Advanced Beneficiary Notice) to sign prior to receiving the treatment.
Even though you may have spoken to a member of our billing department in order that insurance be verified, copayment and deductible be identified and addressed, as well as other issues, ultimately, there is no guarantee by any insurance entity that the procedure will be paid for - or not recouped later. Thus, obtaining an ABN on all such patients is essential.
The Assistant working with the physician in the room for the injection should ensure that the ABN is signed before the surgeon enters the room to perform the injection. Surgeons: Please verify that a signed ABN has been obtained with your Assistant prior to performing the treatment.
If the insurance does not pay for the injection, we will not be able to seek reimbursement from the patient.