Medicare Contract Information
The offices of Konikoff Periodontics & Dental Implants/Wisdom Teeth has chosen to opt out of participating with Medicare. Please review the following statements on the private contract you will be asked to sign at your consultation appointment.
- I understand that Konikoff Periodontics & Dental implants / Wisdom Teeth 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, Justin Hoag and Caroline Webber.
- 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 / Wisdom Teeth and they have elected to opt out of Medicare.