MEDICARE PATIENTS. 1. Although Patient may be an eligible Medicare beneficiary, Practice has informed Patient that Dr. Day (Physician) has opted out of the Medicare program effective Oct 1, 2019 for a period of at least two years. Physician has voluntarily opted out of Medicare participation and has not been excluded in any way.
MEDICARE PATIENTS. I understand that Medicare may deny payment for certain services such as services they determine are not medically necessary and I agree to be personally and fully responsible for any such charges.
MEDICARE PATIENTS. If you have Medicare as your primary insurance carrier, but you do not have a secondary insurance, you are responsible for the deductible, copay and co-insurance at the time of service. You are also responsible to pay for services not covered by your Medicare insurance unless you have a secondary insurance. You will be required to sign an Advanced Beneficiary Notice for non-covered services.
MEDICARE PATIENTS. SIGNATURE ON FILE-‐ I request and authorize payments of Medicare benefits be made to Gainesville Heart and Vascular Group, PC. for any services furnished me by the listed provider/supplier. I authorized any holder of medical information about me to release to the Centers for Medicare and Medicaid Service and its agents any information needed to adjudicate these benefits for services. I understand my signature requests that payment be made and authorizes release of all information necessary to adjudicate the claim. If “other health insurance” is indicated in Item 9 of the CMS-‐1500 form or their approved claim forms or electronically submitted claims, my signature authorizes the release of all information to the insurer as necessary to adjudicate the claim. In Medicare assigned cases, the provider or supplier agrees to accept the charge determination of the Medicare carrier as the full charge, and that I am responsible for the deductible, coinsurance, and any non-‐covered services.
MEDICARE PATIENTS. If any patient referred to you through our Services is a Medicare beneficiary, then notwithstanding anything to the contrary in this or any other agreement with us, the patient will only pay the Initial Payment for use of our Service to hold an appointment. UBERDOC will only pay you only the Initial Payment less applicable Transaction Fees. You shall not be entitled to any consultation fee through UBERDOC for consultations to Medicare beneficiaries. If you are a Medicare provider, you agree that any services rendered by you to a Medicare beneficiary (including the initial consultation) will be billed through Medicare in accordance with government regulations and that you will not xxxx the patient directly.
MEDICARE PATIENTS. 1. Although Patient may be an eligible Medicare beneficiary, Practice has informed Patient that Xx. Xxxxxxxxx (Physician) has opted out of the Medicare program effective June 1, 2018 for a period of at least two years. Physician has voluntarily opted out of Medicare participation and has not been excluded in any way.
MEDICARE PATIENTS. We are a participating facility in the Medicare program. No fees are due at the time of service. We will submit the claim for the patient, as well as all claims to any secondary and third insurance companies. The pa- tient/guarantor is responsible for any balance due after all insurance companies have made payment.
MEDICARE PATIENTS. We are participating provider with Medicare and will bill Medicare for all your charges. If you have supplemental insurance, we will also bill that for you. If payment is not received from your supplemental insurance within 45 days of being submitted, we will bill you for the balance due. If you do not have supplemental insurance, your portion (20% of amount allowed by Medicare) will be collected at the time of service
MEDICARE PATIENTS. Medicare may not cover some services your doctor recommends. All Medicare patients’ procedures will be performed at El Camino Hospital Mountain View. Self-Pay Self-pay patients are those patients without insurance coverage or are receiving a service not covered by their Plan. Self-pay patients are required to pay for any charges at time of service. Self-pay rates are dependent upon the procedure being performed. For more information ask for the office manager.
MEDICARE PATIENTS. You are responsible for your yearly deductible and the 20% portion not paid by Medicare if you do not have secondary insurance • If you have supplemental coverage, as a courtesy we will submit the claims for you. • If you are enrolled in a Medicare HMO plan (such as Oxford, Aetna, United Healthcare, HIP, etc.), or if your Medicare HMO plan has changed, it is your responsibility to inform our staff before your visit. • If the appropriate referrals are not obtained, you will be responsible for full payment of fees. SELF PAY PATIENTS: • Payment in full is expected at time of service.
