Common use of Obligations of Beneficiary Clause in Contracts

Obligations of Beneficiary. 1. Beneficiary or his/her legal representative agrees to be fully responsible for payment of all items or services furnished by Psychologist and understand that no reimbursement will be provided under the Medicare program for such items or services. 2. Beneficiary or his/her legal representative acknowledges and understands that no limits under the Medicare program (including the limits under section 1848 (g) of the Social Security Act) apply to amounts that may be charged by Psychologist for such items or services. 3. Beneficiary or his/her legal representative agrees not to submit a claim to Medicare and further agrees not to ask Psychologist to submit a claim to Medicare. 4. Beneficiary or his/her legal representative understands that Medicare payment will not be made for any items or services furnished by Psychologist that would have otherwise been covered by Medicare if there were no private contract and a proper Medicare claim had been submitted. 5. Beneficiary or his/her legal representative enters into this contract with the knowledge and understanding that he/she has the right to obtain Medicare-covered items and services from psychologists and practitioners who have not opted out of Medicare, and that the Beneficiary is not compelled to enter into private contracts that apply to other Medicare-covered services furnished by other psychologists or practitioners who have not opted out of Medicare. 6. Beneficiary or his/her legal representative understands that Medigap plans (under section 1882 of the Social Security Act) do NOT, and other supplemental insurance plans may elect not to, make payments for such items and services not paid for by Medicare. 7. Beneficiary or his/her legal representative acknowledges that the Centers for Medicare and Medicaid Services (CMS) has the right to obtain copies of this contract upon request.

Obligations of Beneficiary. 1. Beneficiary or his/her legal representative agrees to be fully responsible for payment of all items or services furnished by Psychologist Practitioner and understand understands that no reimbursement will be provided under the Medicare program for such items or services. 2. Beneficiary or his/her legal representative acknowledges and understands that no limits under the Medicare program (including the limits under section 1848 184B (g) of the Social Security Act) apply to amounts that may be charged by Psychologist Practitioner for such items or services. 3. Beneficiary or his/her legal representative agrees not to submit a claim to Medicare and further agrees not to ask Psychologist Practitioner to submit a claim to Medicare. 4. Beneficiary or his/her legal representative understands that Medicare payment will not be made for any items or services furnished by Psychologist Practitioner that would have otherwise been covered by Medicare if there were no private contract and a proper Medicare claim had been submitted. 5. Beneficiary or his/her legal representative enters into this contract with the knowledge and understanding that he/she has the right to obtain Medicare-covered items and services from psychologists Practitioners and practitioners who have not opted out of Medicare, and that the Beneficiary is not compelled to enter into private contracts that apply to other Medicare-covered services furnished by other psychologists Practitioners or practitioners who have not opted out of Medicare. 6. Beneficiary or his/her legal representative understands that Medigap plans (under section 1882 of the Social Security Act) do NOT, and other supplemental insurance plans may elect not to, make payments for such items and services not paid for by Medicare. 7. Beneficiary or his/her legal representative acknowledges that the Centers for Medicare and Medicaid Services Health Care Financing Administration (CMSHCFA) has the right to obtain copies of this contract upon request.

Obligations of Beneficiary. 1. Beneficiary or his/her legal representative agrees to be fully responsible for payment of all items or services furnished by Psychologist Physician and understand that no reimbursement will be provided under the Medicare program for such items or services. 2. Beneficiary or his/her legal representative acknowledges and understands that no limits under the Medicare program (including the limits under section 1848 (g) of the Social Security Act) apply to amounts that may be charged by Psychologist Physician for such items or services. 3. Beneficiary or his/her legal representative agrees not to submit a claim to Medicare and further agrees not to ask Psychologist Physician to submit a claim to Medicare. 4. Beneficiary or his/her legal representative understands that Medicare payment will not be made for any items or services furnished by Psychologist Physician that would have otherwise been covered by Medicare if there were no private contract and a proper Medicare claim had been submitted. 5. Beneficiary or his/her legal representative enters into this contract with the knowledge and understanding that he/she has the right to obtain Medicare-covered items and services from psychologists physicians and practitioners who have not opted out of Medicare, and that the Beneficiary is not compelled to enter into private contracts that apply to other Medicare-Medicare- covered services furnished by other psychologists physicians or practitioners who have not opted out of Medicare. 6. Beneficiary or his/her legal representative understands that Medigap plans (under section 1882 of the Social Security Act) do NOT, and other supplemental insurance plans may elect not to, make payments for such items and services not paid for by Medicare. 7. Beneficiary or his/her legal representative acknowledges that the Centers for Medicare and Medicaid Services (CMS) has the right to obtain copies of this contract upon request.

Obligations of Beneficiary. 1. Beneficiary or his/her legal representative agrees to be fully responsible for payment of all items or services furnished by Psychologist Physician and understand understands that no reimbursement will be provided under the Medicare program for such items or services. 2. Beneficiary or his/her legal representative acknowledges and understands that no limits under the Medicare program (including the limits under section 1848 184B (g) of the Social Security Act) apply to amounts that may be charged by Psychologist Physician for such items or services. 3. Beneficiary or his/her legal representative agrees not to submit a claim to Medicare and further agrees not to ask Psychologist Physician to submit a claim to Medicare. 4. Beneficiary or his/her legal representative understands that Medicare payment will not be made for any items or services furnished by Psychologist Physician that would have otherwise been covered by Medicare if there were no private contract and a proper Medicare claim had been submitted. 5. Beneficiary or his/her legal representative enters into this contract with the knowledge and understanding that he/she has the right to obtain Medicare-Medicare- covered items and services from psychologists physicians and practitioners who have not opted out of Medicare, and that the Beneficiary is not compelled to enter into private contracts that apply to other Medicare-covered services furnished by other psychologists physicians or practitioners who have not opted out of Medicare. 6. Beneficiary or his/her legal representative understands that Medigap plans (under section 1882 of the Social Security Act) do NOT, and other supplemental insurance plans may elect not to, make payments for such items and services not paid for by Medicare. 7. Beneficiary or his/her legal representative acknowledges that the Centers for Medicare and Medicaid Services Health Care Financing Administration (CMSHCFA) has the right to obtain copies of this contract upon request. Beneficiary or his/her legal representative further acknowledges his/her understanding that Physician has been excluded from participation under the Medicare program under section 1128, 1156, 1892, or any other sections of the Social Security Act.

Obligations of Beneficiary. 1. Beneficiary or his/her legal representative agrees to be fully responsible for payment of all items or services furnished by Psychologist Physician and understand that no reimbursement will be provided under the Medicare program for such items or services. 2. Beneficiary or his/her legal representative acknowledges and understands that no limits under the Medicare program (including the limits under section 1848 (g) of the Social Security Act) apply to amounts that may be charged by Psychologist Physician for such items or services. 3. Beneficiary or his/her his legal representative agrees not to submit a claim to Medicare and further unless the filing of such claim is required to obtain secondary coverage for Physician’s charges. Beneficiary agrees not to ask Psychologist Physician to submit a claim to Medicare. 4. Beneficiary or his/her legal representative understands that Medicare payment will not be made for any items or services furnished by Psychologist Physician that would have otherwise been covered by Medicare if there were no private contract and a proper Medicare claim had been submitted. 5. Beneficiary or his/her legal representative enters into this contract with the knowledge and understanding that he/she has the right to obtain Medicare-Medicare- covered items and services from psychologists physicians and practitioners who have not opted out of Medicare, and that the Beneficiary is not compelled to enter into private contracts that apply to other Medicare-covered services furnished by other psychologists physicians or practitioners who have not opted out of Medicare. 6. Beneficiary or his/her legal representative understands that Medigap plans (under section 1882 of the Social Security Act) do NOT, and other supplemental insurance plans may elect not to, make payments for such items and services not paid for by Medicare. 7. Beneficiary or his/her legal representative acknowledges that the Centers for Medicare and Medicaid Services (CMS) has the right to obtain copies of this contract upon request.

Obligations of Beneficiary. 1. Beneficiary or his/her legal representative agrees to be fully responsible for payment of all items or services furnished by Psychologist Physician and understand that no reimbursement will be provided under the Medicare program for such items or services. 2. Beneficiary or his/her legal representative acknowledges and understands that no limits under the Medicare program (including the limits under section 1848 (g) of the Social Security Act) apply to amounts that may be charged by Psychologist Physician for such items or services. 3. Beneficiary or his/her legal representative agrees not to submit a claim to Medicare and further agrees not to ask Psychologist Physician to submit a claim to Medicare. 4. Beneficiary or his/her legal representative understands that Medicare payment will not be made for any items or services furnished by Psychologist Physician that would have otherwise been covered by Medicare if there were no private contract and a proper Medicare claim had been submitted. 5. Beneficiary or his/her legal representative enters into this contract with the knowledge and understanding that he/she has the right to obtain Medicare-covered items and services from psychologists physicians and practitioners who have not opted out of Medicare, and that the Beneficiary is not compelled to enter into private contracts that apply to other Medicare-Medicare- covered services furnished by other psychologists physicians or practitioners who have not opted out of Medicare. 6. Beneficiary or his/her legal representative understands that Medigap plans (under section 1882 of the Social Security Act) do NOT, and other supplemental insurance plans may elect not to, make payments for such items and services not paid for by Medicare. 7. Beneficiary or his/her legal representative acknowledges that the Centers for Medicare and Medicaid Services (CMS) has the right to obtain copies of this contract upon request.