What is the name of the form given to Medicare patients explaining that the cost of a procedure is the responsibility of the patient?

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This form is called an Advanced beneficiary notice. It is given to Medicare patients when a healthcare provider believes that Medicare may not cover a particular service or procedure. The form explains why Medicare may not cover the service, the estimated cost of the service, and informs the patient that they may be responsible for the cost. By signing the form, the patient acknowledges that they have been informed of their financial responsibility.

What Is the Name of the Form Given to Medicare