Common Contracts
1 similar Medicare Opt-Out Agreement contracts
Complete the following form if you have Medicare:Medicare Opt-Out Agreement • January 30th, 2022
and is a Medicare Part B beneficiary seeking services covered under Medicare Part B pursuant to Section 4507 of the Balanced Budget Act of 1997. Dr. Lisa Mainier has informed Beneficiary or his/her legal representative that she has opted out of the Medicare program effective on July 1, 2016 for a period of at least two years. Dr. Mainier is not excluded from participating in Medicare Part B under [1128] 1128, [1156] 1156, or [1892] 1892 of the Social Security Act.
