We do not collect personal or corporate e-mail addresses, or any personally identifiable information on visitors to our site, without your permission. We reserve the right to collect operational information, including through reliance on “cookies,” such as the pages you access or visit, your IP address, your domain name, the last URL you visited before clicking to our site, and your browser and platform type (e.g., a Netscape browser on a Macintosh computer). This information may be used to measure usage, number of visits, average time spent on the site, pages viewed, etc., and to improve the content of our site. None of the foregoing would allow us or a third party to identify you or contact you. It is used for internal review only and not shared with other organizations for commercial purposes without first providing notification to you.
Our website uses links that allow visitors to contact us via e-mail for a variety of purposes. Communications through our website or via email are not encrypted, which can create a risk to the privacy and security of those communications. We cannot guarantee or warrant the security of any data you submit to us. Emails you receive from us may contain personal information (including health information) that are not encrypted or otherwise secure. That information may be accessed by unauthorized third parties. We may elect to save such information, share it with third parties, or discard it entirely. However, we will use reasonable efforts to treat as confidential any emails, questions, or inquiries sent to us for the purpose of inquiring into our services. Any e-mail or document you send to us will be used only for internal purposes.
By visiting this site, you hereby give your consent to our practice to contact you by either phone or email using the information you provide and agree that any email we send you may not be encrypted or otherwise secure. You agree that we may include your personal information (including health information) in emails that we send to you or your representatives. You agree to assume any and all risks relating to our use of email to contact or communicate with you. You further agree to hold our practice, its doctors and affiliates, harmless from any liability arising from our use of email to contact or communicate with you and that you will not seek to hold us liable in the event any information in those emails is accessed or acquired by any unauthorized party.
MEDICARE PRIVATE CONTRACT
A provision in the Social Security Act permits Medicare beneficiaries and physicians to contract privately outside of the Medicare program. Under the law as it existed prior to January 1, 1998, a physician was not permitted to charge a patient more than a certain percentage in excess of the Medicare fee schedule amount. A new provision, which became effective on January 1, 1998 permits physicians and patients to enter into private arrangements through a written contract under which the patients may agree to pay the physician more than that which would be paid under the Medicare program.
A “private contract” is a contract between a Medicare beneficiary and a physician or other practitioner who has opted out of Medicare for two years for all covered items and services he/she furnishes to Medicare beneficiaries. In a private contract, the Medicare beneficiary agrees to give up Medicare payment for services furnished by the physician/ practitioner and to pay the physician/ practitioner without regard to any limits that would otherwise apply to what the physician/ practitioner could charge.
Physician has opted out of the Medicare program as of July 1, 2016. The opt-out will not expire until at least June 30, 2018. Under this contract, the patient (who is otherwise a Medicare Beneficiary) elects to continue treatment with Physician even though Physician has opted out of Medicare and is not bound by the Medicare physician fee schedule. This agreement is limited to the financial arrangement between the Physician and Patient and is not intended to obligate either party to a specific course or duration of treatment.
Patients and physicians who take advantage of this provision are not permitted to submit claims or to expect payment for those services from Medicare.
In an emergency or urgent care situation, a physician/practitioner who opts out may treat a Medicare beneficiary with whom he/she does not have a private contract and bill for such treatment. In such a situation, the physician/ practitioner may not charge the beneficiary more than what a non-participating physician/practitioner would be permitted to charge and must submit a claim to Medicare on the beneficiary’s behalf. Payment will be made for Medicare covered items or services furnished in emergency or urgent situations when the beneficiary has not signed a private contract with that physician/practitioner.
A. Obligations of Physician
- Physician agrees to provide such treatment as may be mutually agreed upon by the parties and at mutually agreed upon fees
- Physician agrees not to submit any claims under the Medicare program for any items or services even if such items or services are otherwise covered by Medicare
- Physician acknowledges that he/she will not execute this contract at a time when the Patient is facing an emergency or urgent health situation
B. Obligations of Patient
- Patient or his/her legal authorized representative agrees not to submit a claim (or to request that the Physician submit a claim) under the Medicare program (including Medicare + Choice Plan) for such items or services as Physician may provide, even if such items or services are otherwise covered under the Medicare program (“Medicare Covered Services”)
- Patient or his/her legal authorized representative agrees to be responsible for full payment of such items or services and understand that no reimbursement will be provided under the Medicare program for such items or Medicare Covered Services.
- Patient or his/her legal authorized representative acknowledges that Medicare limits do not apply to what the physician/practitioner may charge for items or Medicare Covered Services furnished by the physician/practitioner
- Patient acknowledges that Medigap plans DO NOT, and other supplemental insurance plans may elect not to, make payments for items and Medicare Covered Services not paid for by Medicare
- Patient acknowledges that he/she has the right to obtain Medicare-Covered Services from physicians and practitioners who have not opted out of Medicare, and that he/she is not compelled to enter into private contracts that apply to other Medicare Covered Services furnished by other physicians or practitioners who have not opted who, and can have these services furnished by such other physicians and practitioners who have not opted out.
- Patient acknowledges that he/she or his/her legal representative understand that Medicare payment will not be made for any items or Medicare Covered Services furnished by the physician/practitioner that would have otherwise been covered by Medicare if there were no private contract and proper Medicare claim had been submitted
- Patient acknowledges that physician has opted out of the Medicare program for services provided as of July 1, 2016. The opt-out will not expire until at least June 30, 2018. Patient acknowledges that Physician is not bounded by the Medicare Physician Fee Schedule
C. Physician’s Status
Patient further acknowledges his/her understanding that Physician has not been excluded from participation under the Medicare program under section 1128.
D. Term and Termination
Physician has opted out of the Medicare program as of July 1, 2016. This agreement shall commence on the opt-out renewal date of July 1, 2016 and shall continue in effect until June 30, 2018. Despite the term of the agreement, either party may choose to terminate treatment with reasonable notice to the other party. Notwithstanding this right to terminate treatment, both Physician and Patient agree that the obligation not to pursue Medicare reimbursement, for items and services provided under this contract, shall survive this contract.
This policy may be changed from time to time, consistent with the requirements of our business or government regulations. You can determine when this policy was last revised by referring to the “Last update” date at the bottom of this page. Unless otherwise required by law, any changes to this policy will become effective upon our posting of a revised policy on the Site.