Medicare Contract Information

Konikoff Periodontics & Dental Implants 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 Periodontics & Dental implants Doctors have chosen to opt out of   Medicare.
•  I accept full responsibility for the fees due for all services performed by Drs. Albert Konikoff,   Bryan Konikoff,  Khin MiMi San and Justin Hoag.
•  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 Periodontics & Dental Implants and   they have elected to opt out of Medicare.