Advance Beneficiary Notice of Noncoverage (ABN)
NOTE: If Medicare doesn’t pay for D. LASIK below, you may have to pay. Medicare does not pay for everything, even some care that you or your healthcare provider have good reason to think you need. We expect Medicare or may not pay for the D. LASIK below.
E. Reason Medicare May Not Pay: Not Medically Necessary
F. Estimated Cost: $5000 for both eyes
WHAT YOU NEED TO DO NOW:
• Read this notice, so you can make an informed decision about your care.
• Ask us any questions that you may have after you finish reading.
• Choose an option below about whether to receive the D. LASIK listed above.
Note: If you choose Option 1 or 2, we may help you to use any other insurance that you might have, but Medicare cannot require us to do this.