Obligations of Physician. 1. Physician agrees to provide such treatment as may be mutually agreed upon by the parties and at mutually agreed upon fees.
Obligations of Physician. Physician shall have the following duties and responsibilities:
Obligations of Physician. Dr. Xxxx Xxxxxxx agrees to provide medical services to the Patient and in exchange for these services the Patient agrees to make payments directly to Dr. Xxxx Xxxxxxx at the time of service, pursuant to Dr. Xxxx Xxxxxxx’x current fee schedule. Dr. Xxxx Xxxxxxx agrees not to submit any claims under the Medicare program for any items or services even if such items or services are otherwise covered by Medicare. Obligations of Patient ✓ Patient or his/her authorized legal representative agrees not to submit a claim (or to request that Physician submit a claim) under the Medicare program for items or services Physician may provide, even if such items or services are otherwise covered under the Medicare program. ✓ Patient or his/her authorized legal representative agrees to be responsible for payment in full for items or services provided and understands that no reimbursement will be provided under the Medicare program for such items or services. ✓ Patient or his/her authorized legal representative understands that Medicare will not reimburse Patient for any service provided by the Center for Health & Healing since Xx. Xxxxxxx has opted out of the Medicare program. ✓ Patient or his/her authorized legal representative acknowledges that Medicare limits do not apply to what Physician may charge for items or services furnished. ✓ Patient or his/her authorized legal representative acknowledges that Physician will not submit a claim on any service provided. ✓ Patient or his/her authorized legal representative acknowledges that Medigap plans do not, and other supplemental insurance plans may elect not to, make payments for items and services not paid for by Medicare. ✓ Patient or his/her authorized legal representative acknowledges that (s)he has the right to obtain Medicare-covered items and services from physicians and practitioners who have not opted out of Medicare, and that (s)he is not compelled to enter into private contracts that apply to other Medicare covered services furnished by other physicians or practitioners who have not opted out. ✓ Patient or his/her authorized legal representative agrees not to request that Physician submit a claim to a secondary carrier. ✓ Patient is not currently in an emergency or urgent health care situation. Patient understands Physician is not a Primary Care Physician and does not treat patients in an emergency state. If Patient is in an Urgent or Emergency condition, (s)he should immediately go to an Urgent Care facility or Em...
Obligations of Physician
