Advance Beneficiary Notice of Non-coverage (ABN) - LCOHPA

Megan Schrantz LPCC

Advance Beneficiary Notice of Non-coverage (ABN) (Megan Schrantz LPCC) - LCOHPA

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A. Notifier: Lindner Center of HOPE Professional Associates

B. Patient Name:*
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Advance Beneficiary Notice of Non-coverage (ABN) (ABN)

NOTE: If Medicare doesn’t pay for D. Outpatient below, you may have to pay. Medicare does not pay for everything, even some care that you or your health care provider have good reason to think you need. We expect Medicare may not pay for the D. Outpatient below.

D. E. Reason Medicare May Not Pay: F. Estimated Cost:
Medicare A & B: Outpatient Therapy & Medication Megan Schrantz, LPCC is not a Medicare provider, therefore Medicare will not pay for her services. $60-$240 per visit
Medicare Part D: Pharmacy Medicare will also not pay for prescriptions written by Non-Medicare providers.
Enter Applicable YTD Range/Duration:


  • 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. Outpatient 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.
G. OPTIONS: Check only one box. We cannot choose a box for you.*

H. Additional Information:

This notice gives our opinion, not an official Medicare decision. If you have other questions on this notice or Medicare billing, call 1-800-MEDICARE (1-800-633-4227/TTY: 1-877-486-2048). Signing below means that you have received and understand this notice. You also receive a copy.

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CMS does not discriminate in its programs and activities. To request this publication in an alternative format, please call: 1-800-MEDICARE or email: [email protected].

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