Private-Pay (Opt-Out) Medical Services Contract*
Section 4507 of the 1997 Balanced Budget Act allows a physician or practitioner, such as a Licensed Marriage and Family Therapist, to enter a private contract with a Medicare beneficiary.
Why a special contract?
I have not been excluded from providing medical services under Social Security Act Medicare (including sections 1128, 1156, 1892, CFR § 405, subpart D.) I, Carla Turturici, Licensed Marriage & Family Therapist, have chosen to separate myself (“opt out”) from Medicare. My current opt-out started January 1, 2024, and will automatically renew every two years. Because I opted out, Medicare requires I have you sign a private-pay medical services contract before we begin therapy services.
Who pays for services?
You are responsible for payment. You will have to use your own money to pay the entire cost of my services.
Are there charge limits?
No, Medicare charge limits do not apply to products or counseling services you receive from me through this private-pay medical services contract. I am able to charge you whatever amount you and I agree to.
Will Medicare help pay?
No, Medicare will not help pay your bill. Because I separated from Medicare, it is against the rules for you to send a bill to Medicare for my services or ask to send the bill to Medicare for you.
But isn’t this a medicare covered service?
Yes and no. Yes, Medicare would pay for the same service received from a provider, who is connected to Medicare. No, Medicare will not pay, because I have chosen to separate myself from Medicare.
What options do I have?
You have the right to receive your product or service from a provider connected to Medicare or from me, a provider separated from Medicare. Even if you get your product or services from me, you can always get products and services from providers connected to Medicare. These providers are not required to have you sign private-pay medical services contracts.
What if I am having a medical emergency?
This contract does not cover emergency or urgent care services. If you have an emergency or urgent medical need, ask me for help. It is against Medicare rules for me to have you sign a private-pay medical services contract for emergency or urgent medical services.
Will my Medigap or other supplemental plan help pay?
No, Medigap plans will not help pay for products or services you get from me. If you have some other medical insurance plan, it might not help pay your bill either.
What else do I need to do?
If you decide to sign a private-pay opt-out medical services contract with me, we will review the contract together to ensure you understand the agreement. I will share a copy of the signed agreement for you to keep. This way you will have a copy to look at if you have any questions about the contract in the future.
Will the Centers for Medicare & Medicaid Services (CMS) get a copy of the contract?
I, the provider, will supply a copy of this contract in the event CMS requests a copy.
* Private-Pay (Opt-Out) Medical Services Contract was sourced from Noridian Healthcare Solutions, LLC website.