Medicare Beneficiaries. Enrollees who become eligible for Medicare will be disenrolled effective the first of the month of notification to the Medicaid and BadgerCare programs from the Social Security Administration (SSA). Even if SSA awards Medicare eligibility retroactively, the effective date of HMO disenrollment will be the first of the month of notification.
Medicare Beneficiaries. If you are a patient who is entitled to benefits under or is enrolled in Medicare Part B, you acknowledge that HIM has not been excluded from participation under the Medicare program and understand that HIM has voluntarily elected to opt out of the Medicare program. You agree not to submit a claim or request HIM submit a claim under the Medicare program or to any intermediary or carrier of the Medicare Program for any portion of the membership fee or physician services billed to you by HIM even if the services are covered by Medicare. You acknowledge that you will be responsible for payment of such services and that no reimbursement will be provided under the Medicare program or any Medigap plan for the membership fee or xxxx for physician services and that other supplemental insurance plans may elect not to reimburse you for such items. You further acknowledge that the limits the Medicare program places on what a physician participating in the Medicare program may charge for services rendered do not apply to the membership fee or to any physician services xxxx rendered to you by HIM. Further, you acknowledge that (a) you have the right to obtain Medicare-covered services from physicians who have not opted out of the Medicare program, (b) you are currently not facing an emergency or urgent healthcare situation, and (c) you have voluntarily elected to enter into this membership agreement for the provision by HIM of services that might be eligible for payment or reimbursement by Medicare if the services were provided by a physician who continued to participate in the Medicare program subject to the submission of an appropriate Medicare claim.
Medicare Beneficiaries. If Patient is eligible for Medicare, or during the term of this Agreement becomes eligible for Medicare, then Patient understands that the Practice and Providers do not accept Medicare for the services rendered at SHD. Patient’ understands Medicare cannot be billed for any services performed for the Patient by the Practice. By signing this agreement Patient agrees not to xxxx Medicare or attempt Medicare reimbursement for the Services.
Medicare Beneficiaries. By signing this Agreement, you specifically acknowledge that pursuant to federal regulations, Medicare Beneficiaries are not permitted to enter into this Agreement. If you are eligible for Medicare, or during the term of this Agreement you become eligible for Medicare, then you must immediately notify Practice. This Agreement will automatically terminate commensurate with your Beneficiary eligibility status and any refundable Monthly Fee will be returned to you, or applied to your financial obligations as a Beneficiary, as the case may be, subject to any applicable regulatory restrictions. You specifically agree that you will not xxxx Medicare or attempt Medicare reimbursement for any Services provided under this Agreement.
Medicare Beneficiaries. If Patient is eligible for Medicare, or during the term of this Agreement becomes eligible for Medicare, then Patient will sign Appendix A to this Agreement, attached hereto and incorporated by reference. Appendix A documents Patient’s understanding that all Physicians employed by the Practice have opted out of Medicare, and as a result, Medicare cannot be billed for any services performed for Patient by the Practice. By signing Appendix A, Patient agrees not to xxxx Medicare or attempt Medicare reimbursement for the Services.
