Dpc Patient Agreement

Fees are based on the age of patients ($39 per month for children, $69 per month for adults under 50, $84 for adults 50-64 and $109 per month for adults over 65), with discounts for businesses and other situations, as the doctor has established. 10% discount is offered for one-year payment in full or payment by ACH bank withdrawals rather than credit card. A provision of the Social Security Act allows Medicare beneficiaries and physicians to cancel their private activities outside of medicare. Under the Act, as it existed prior to January 1, 1998, a physician could not charge a patient a percentage greater than a certain percentage beyond the Medicare pricing plan. A new provision, which came into effect on January 1, 1998, allows physicians and patients to enter into private agreements through a written contract whereby the patient must pay the physician more than would be paid under the Medicare program. D. Duration and termination This contract begins on the date mentioned above and applies until – (The physician must insert a date that is two [2] years after [s] signing of the affidavit). Despite the duration of the agreement, each party may terminate the treatment in the event of an appropriate termination of the other party. Notwithstanding this right to terminate treatment, the physician and patient accept that the obligation not to follow Medicare`s reimbursement for the goods and services provided under this contract will last this contract.

6. Insurance or other medical care. The patient recognizes and understands that this agreement is not an insurance plan and does not replace health insurance or any other health insurance (for example. B member of an HMO). It does not cover hospital services or services that are not personally provided by Frontier DPC or its physicians. The patient acknowledges that Frontier DPC has indicated that patients receive or maintain full health insurance or plans to cover the patient`s overheads. The patient acknowledges that this agreement is not a contract that provides for health insurance and that this agreement should not replace existing or future health insurance that the patient can cover. 9. Changing the law. Where there is an amendment to a law, regulation or rule, confederation, state or local state that violates the agreement, including these general terms, which are incorporated by reference to the agreement, or the activities of one of the parties under the agreement, or a change in the judicial or administrative interpretation of such a law. , such a regulation or rule, and each party is reasonably of the right to believe that the amendment will have a significant negative effect on that party`s rights.

, commitments or transactions related to the agreement, this party may then, upon written notification, compel the other party to enter into negotiations in good faith to renegotiate the terms of the agreement, including these terms and conditions of sale. If the parties fail to agree on an amendment to the agreement within forty-five days of the effective date of the amendment, each party may immediately terminate the contract in writing to the other party. Family members who are Medicare beneficiaries must be covered by an opt-out and Medicare waiver agreement to be treated by a DPC border physician. 4. Fee. In exchange for the services described above, the patient agrees to pay Frontier DPC, the amount covered by Schedule 1. This fee is payable at the time of the performance of this contract and is paid for services provided to the patient during the duration of the contract. If this agreement is terminated by one of the parties prior to the termination date of the contract, Frontier DPC reimburses the patient`s share in the initial payment, which remains after deducting individual fees for services provided to the patient until termination.

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