Common Contracts
1 similar Opt-Out Agreement contracts
ContractOpt-Out Agreement • September 29th, 2014
This agreement is between Dr. Lily Hargrove, M.D. and _________________________ , who is Medicare Part B beneficiary seeking services covered under Medicare Part B pursuant to Section 4507 of the Balanced Budget Act of 1997. The Physician has informed Beneficiary or his/her legal representative that Physician has opted out of the Medicare program effective on October 1, 2014 for a period of at least two years, to expire on September 30, 2016. The physician is not excluded from participating in Medicare Part B under [1128] 1128, [1156] 1156, or [1892] 1892 of the Social Security Act.
