Medicare Contract Information

Konikoff Hoag & San Dental Implants & Periodontics has chosen to Opt out of participating with Medicare. Please review the following statements on the private contract before your consultation appointment.

•  I understand that Konikoff Hoag & San Dental Implants & Periodontics Doctors have chosen to opt out of   Medicare.
•  I accept full responsibility for the fees due for all services performed by Drs. Bryan Konikoff,  Justin Hoag and Khin MiMi San.
•  I understand that I am not allowed to submit a claim myself to Medicare for services rendered   or to ask the physician/practitioner to submit a claim to Medicare.
•  I understand that I have the right to obtain Medicare covered services from physicians who   have not opted out of Medicare.  I am not compelled to enter into private contracts that apply   to other Medicare covered services furnished by other physicians who have not opted out.
•  I understand that Medigap plans do not make payments for services not paid for by Medicare.  
•  I understand that this is a private contract with Konikoff Hoag & San Dental Implants & Periodontics and they have elected to opt out of Medicare.