If Medicare denies a surgery claim, do I owe the surgeon?

Health insuranceDeniedChecked Nov 6, 2026

From K.Actuary, founded by Sangmin Kwon, ASA · sources checked 2026-11-06 · Source: Medicare.gov · Your protections (ABN) · ABN and the three options View original ↗

In short

You may owe if you signed an ABN, or if the provider does not accept assignment.
An ABN is a notice that Medicare may not pay.
With Option 2, no claim is sent and you can't appeal.

What this means

Whether you owe the surgeon depends on two things. One is whether you signed an ABN. The other is whether the provider accepts assignment.

An ABN is a written notice. A provider gives it when they think Medicare won't pay [1]. Under Option 1, you want the service and the provider sends a claim to Medicare. If Medicare denies it, you must pay, but you can appeal [1]. Under Option 2, you ask the provider not to send a claim to Medicare, so you can't file an appeal [1].

If the provider accepts assignment, the Medicare-approved amount is payment in full for a covered service [2]. If not, the provider can charge more. In many cases it is not more than 15% above the approved amount [2]. Medicare.gov lists other reasons for a bill. The provider may have opted out, may have given a service Medicare doesn't cover, or may not have collected your deductible and coinsurance [3].

Your next step

Find out if you signed an ABN and which option you checked [1]. Check whether the provider accepts assignment [2]. The sources do not say who must pay in each particular case. The sources give no deadline.

Check it yourself

Your ABN copy is the paper to check. The sources do not say who must pay in each particular case — "Don't know yet".

Where this comes from (3)

[1] Medicare.gov · Your protections (ABN) · ABN and the three options · checked 2026-11-06
This notice is called an "Advance Beneficiary Notice of Non-coverage," or ABN. The ABN lists the items or services that your doctor or health care provider expects Medicare will not pay for, along with an estimate of the costs for the items and services and the reasons why Medicare may not pay. What can I do if I get this notice? On the ABN, you'll be asked to choose an option box and sign the notice to say that you …
[2] Medicare.gov · Does your provider accept Medicare as full payment? · assignment; limiting charge · checked 2026-11-06
accepts the Medicare-approved amount as payment in full for a covered service … They can charge you more than the Medicare-approved amount. In many cases, the charge can't be more than 15% above the Medicare-approved amount for non-participating healthcare providers. This amount is called "the limiting charge
[3] Medicare.gov · Filing a claim · checked 2026-11-06
If you get a bill, it could be because your doctor, provider, or supplier: Doesn't accept assignment Opted-out of Medicare and entered into a private contract with you Gave you services that aren't covered by Medicare Didn't collect the Medicare deductible and coinsurance amounts you owe when you got services

How we found this

We matched your question to 3 official sources, quoted the exact lines, and re-checked each quote against its source on 2026-11-06.

What we don’t know yet

Your own plan or notice may say something different. If your letter cites another rule, send it and we will look again.

Every answer is checked against the official rule it quotes.

Information only — not legal advice. Your plan, insurer or agency decides.

This answer quotes the official sources listed above, with the date we checked them. Your own policy, notice and state rules control. We are not your lawyer or your insurer. We don’t file, argue or negotiate claims for you — you send any letter or form yourself.

Ask a question Get help with my claim