1601 N. Tucson Blvd. Suite 9
Tucson, AZ 85716-3450
Phone: (800) 635-1196
Hotline: (800) 419-4777
Association of American Physicians and Surgeons, Inc.
A Voice for Private Physicians Since 1943
Omnia pro aegroto

Sample Letter #2 Informing Medicare Patients of Decision to Opt-Out of Medicare

March 1, 2003
We are writing to notify our Medicare patients of a recent decision we have made in our practice, and to explain its benefits and its impact on you. As you know, our new medical practice is in a small, personal office setting (please refer to our information packet for details). In order to spend more time with our patients and to decrease practice complexity and administrative costs, we do not have any insurance/third party billing services (including government programs such as Medicare).

You may not know that it is voluntary for doctors to contract with Medicare. Once contracted, he/she must comply with Medicare's numerous restrictions/regulations (often quite complex and confusing) and can only be paid the fixed amount that Medicare will allow. Even if the patient desires to pay the doctor's real charges, it is prohibited by Medicare.

Doctors may choose NOT to contract with Medicare since it is a voluntary system. We have made the decision to not contract with Medicare effective April 1, 2003. We will still be offering you our medical services, but it will be outside of the Medicare payment system. You will be asked to pay us directly for our services as we do with our non-Medicare patients. Due to Medicare regulations, you will receive no reimbursement from Medicare/the Federal Government/secondary (medigap) insurance for our services.

There will be NO change in your Medicare benefits. Your Medicare and secondary insurance benefits will continue to be in full effect for lab, x-rays, hospital services and for services you receive from all doctors contracted with Medicare. This change only affects our charges. There will be NO changes in our medical services to you.

You will be given a payment receipt for our services which may be useful for tax purposes, but it cannot be sent to Medicare OR your secondary insurance for reimbursement. Fortunately, as Family Physicians we do not perform major surgical or other procedures that can be quite costly. Also, our charges are reasonable given that we pass on our administrative cost savings to our patients. A copy of our sample charges is attached for your review.

In our opinion, when a doctor decides not to contract with Medicare there are wonderful benefits for both doctors and patients. They are free to have a private professional relationship which means they make individual agreements on medical services and on reimbursement for these services which is fair to both. Whereas the terms are set and agreed to voluntarily by the doctor and the patient only, mutual fairness is the natural result. This is the type of relationship we want to have with our patients!

In order to be treated by us after April 1, 2003 it will be necessary (as dictated by Medicare) for you to sign and return to us the enclosed private contract. We understand that some of our Medicare patients may not find this acceptable financially, and we will at your request transfer your records to a physician of your choice (We have included in this mailing a records transfer). However, we certainly hope to continue to care for you in our practice!

Thank you for your consideration, and please let us know if there any questions we can assist you with!

Your Doctor