Common Contracts
1 similar Medicare Private Contract contracts
Medicare private contract for patients 65 years and olderMedicare Private Contract • April 14th, 2015
This contractual agreement is between Dr. O’Leary (Dentist), whose principal place of business is at 9321 Martin Way E., Suite 101, Lacey, WA 98516 and (patient), a Medicare Part B beneficiary. As a Dentist that has opted out of the Medicare program on 10/1/2013 for at least two years, Dr. O’Leary has informed Patient that treatment she provides to any Medicare beneficiary is not subject to Medicare limits. Pursuant to Dentists’ “Opt Out” agreement with Medicare. Patient has also been informed that Dentist is prohibited from billing Medicare for services provided to patient. As required by law, this agreement clearly states that Dr. O’Leary is a provider in good standing with the Medicare program under section 1128, 1156, 1982 of the Social Security Act.
