Get Anthem Bc Abn Form

Filling out the Anthem BC Advance Beneficiary Notice (ABN) Form online can help users manage their healthcare services effectively. This guide provides clear, step-by-step instructions to assist users in completing the form accurately.

Follow the steps to complete your Anthem BC ABN form online

1. Press the ‘Get Form’ button to access the Anthem BC ABN Form and open it in your preferred editing tool.
2. Begin by entering your name in the 'Patient Name' field. This should be your full legal name as it appears on your identification documents.
3. Next, input your unique patient number in the designated 'Patient Number' section. This number is typically assigned by your healthcare provider.
4. Fill out the 'Payor' field with the name of the insurance provider that is responsible for your healthcare coverage.
5. In the 'Date of Notice' section, enter the current date when you are completing the form.
6. Identify the services you believe may be denied by the payor by providing a description in the 'Description of Services likely to be denied' field.
7. Clearly state the reason for the denial in the corresponding 'Reason For Denial' section. This should reflect the information you received from your provider.
8. Indicate the estimated costs associated with the services noted in the 'Approximate Cost' field, as provided by your healthcare provider.
9. Review the 'Beneficiary Agreement to PAY' section and sign and date the form if you agree to be responsible for payment should a denial occur.
10. Alternatively, if you do not wish to receive the service, complete the 'Beneficiary Refusal to Receive Item or Service at Own Expense' section and provide your signature and date.
11. If applicable, have a witness sign in the designated area if you refuse to sign the ABN after review.
12. After completing all necessary fields, save your changes. You may then choose to download, print, or share the completed form as needed.

Get started now by completing your Anthem BC ABN form online.