How can I have a practice that does not have to deal with health insurance companies or Medicare and where all patients would be self pay regardless of what insurance they may have? If the patients want to submit a claim to their insurance, that would be between them and their insurance company. In my view, we should be able to just hang a sign saying "We accept no insurance. Every patient is personally responsible for the payment of all charges which are due at the time of service". However, it seems impossible.

General Practice Medicine
Miami, FL

A: It is not impossible; however it may be difficult to find patients that agree to that financial arrangement. With respect to Medicare beneficiaries, if you decide to opt out of the Medicare program, you can charge Medicare patients whatever you wish. However, there are a variety of steps that must be taken to "opt out" and comply with Medicare regulations. For starters, in order for you to "opt out" you would need to complete and sign an "opt out affidavit" and submit it to Medicare Registration at First Coast Service Options, Inc. (FCSO). Thereafter, you would need to provide each of your Medicare patients with an "opt out contract" that specifies the conditions such as the fact that they are totally responsible for your fees and cannot even submit a claim to Medicare unassigned. There is a lot of detail to "opting out" of the Medicare program, please refer to www.floridamedicare.com for further information.

As far as private insured patients, you are not obligated to accept their insurance and you can charge them your regular rate at the time of service assuming you have no contractual obligations with any insurance company.

Mr. Frosch is the President of Frosch Medical Consultants, Inc. in Plantation, FL.

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