Self-Pay Practice Notice

Self-Pay (Cash-Only) Internal Medicine Practice

This medical office operates on a self-pay (cash-only) basis.
We do not participate in, bill, or accept Medicare, New Jersey Medicaid (NJ FamilyCare), Medicare Advantage, or any private insurance plan. We do not submit claims to any insurer or government program on your behalf, and we do not accept assignment of insurance benefits.

Payment in full is due from the patient at the time services are rendered.

Important Notice for Medicare and Medicaid Patients Please Read

This practice does not treat patients who are enrolled in, or eligible for, Medicare or New Jersey Medicaid (NJ FamilyCare) — even on a self-pay or cash basis, and even if the patient asks that no claim be submitted. There are no exceptions.

We are not able to accept a Medicare or Medicaid beneficiary as a cash-paying patient. Our physicians participate in Medicare and New Jersey Medicaid through their other medical offices and have not opted out of those programs. Under federal and state law, a physician who participates in Medicare and Medicaid generally may not treat a Medicare or Medicaid patient on a private cash basis for covered services. For that reason, if you are enrolled in or eligible for Medicare or Medicaid, we cannot schedule or provide care to you at this office.

If you are a Medicare or Medicaid beneficiary, please obtain care from a provider that participates in your program. You are free to choose any participating provider you wish.

Patient Eligibility and Confirmation

To keep this practice fully compliant, we confirm eligibility before scheduling and before each visit:

Every patient must confirm that he or she is not enrolled in, and not eligible for, Medicare or New Jersey Medicaid (NJ FamilyCare) before an appointment can be scheduled.

Before your first visit, you will be asked to sign a short acknowledgment confirming that you understand this is a self-pay practice, that we do not bill any insurer or government program, that you are responsible for the full cost of your care, and that you are not a Medicare or Medicaid beneficiary.

If your status changes — for example, if you become eligible for Medicare at age 65 or enroll in Medicaid — please tell us. We will help direct you to a participating provider, as we can no longer provide your care at this office.

Notice Regarding Separate Medical Practices

Chirag Patel, M.D. and Jaimy Patel, M.D. practice medicine at more than one medical office.

This office operates on a self-pay (cash-only) basis and does not accept Medicare, Medicaid, or insurance.

• Other offices operated by Chirag Patel, M.D. and Jaimy Patel, M.D. may participate with Medicare, New Jersey Medicaid (NJ FamilyCare), and private insurance plans. Medicare and Medicaid patients may seek care at a participating office or from any other participating provider of their choosing.

Patients are free to choose where they receive care. No patient is required to receive care at any particular location, and this notice is not intended to direct or steer any patient toward a particular office.

Our Commitment to Compliance

This practice is committed to full compliance with all applicable federal and state health care laws, including Medicare and Medicaid billing rules and the federal fraud-and-abuse laws. This disclosure is provided for transparency and does not create a physician-patient relationship. If you have questions about your Medicare or Medicaid coverage, please contact your program or a benefits counselor.