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                                                    We are dropping out of Medicare and all Insurance as of 10/1/26

                                                                   Dr. Roberts Letter to his personal patients

                                                                          Medicare Beneficiary Acknowledgement Form

                                                                                            Financial Policy

                                                                                              Fee Schedule

                                                      We are dropping out of Medicare and all Insurance as of 9/30/26

What this means for you, as of 10/1/26:
A. Medicare/Insurance will no longer be directly billed for the services we provide.
B. You will pay us directly, at the time of service, for the work we do on your behalf.
C. Medicare/Insurance will still cover prescriptions and requested outside testing.
D. We can provide you an itemized statement with which you could request reimbursement to your Insurance (but not from Medicare or Medicare Advantage).
E. You can continue to receive full Medicare/Insurance coverage from other Doctors.

I am turning 71, a point in my life where:
A. Work is no longer mandatory; I can retire when I want.
B. I have never been this effective helping others.
C. There has never been such an interest in Integrative Cardiology.
D. Fascinating new therapies are being brought to me by patients and colleagues.

So why would I want to retire?  Well, I do not want to, but I have to take action, as:
A. Medicare/Insurance compensation is not covering the effort I put in to your care.
B. Their (really meaningless) paperwork requirements are eating up too much time.
C. As such, to make 1/3^rd of my late 30s salary (when I was doing more procedures than anyone else), I will have to work additional hours (you see how hard I am working now),
and I am not going to do that.
D. Medicare reimburses us 5% less than other practices, and have announced further financial constraints, if we do not adopt an electronic medical records (EMR) system.

Medicare does not cover knowledge (I topped the class a lot in College and Med School), experience (my 40 years), innovation (here I have an extensive track record), and above all, good outcomes.  You get a lot out of our visits because I spend four hours preparing for each 10-hour office day (which does not figure in to Medicare reimbursement).

Medicare pays well, however, for procedures, particularly invasive procedures, that American patients seem to require over and over – but I am not compensated for my efforts (and success) in keeping you out of the hospital and out of the procedure suite.

I’ve had my fill of this, and now with the reimbursement cut off threat I have decided to drop out of Medicare and Insurance. I am not being “forced out” by Medicare; I am leaving voluntarily, for the reasons outlined above.
And by the way, I have never been sued, I have never received a sanction or warning regarding a patient care activity or decision, nor have I ever been awarded a speeding ticket! I got my Eagle Badge at the minimum age of 13 and live my life on proper principles (you figured this out - why you see me in the first place).

My Medicare opt-out will leave many of you “out in the cold”, but if I retire, all stakeholders will be left with nothing.

 It is up to you whether to stay or to take a different direction.  Please think this over and let us know as soon as possible.

If you stay:
A. Please complete the applicable attached forms (Medicare Beneficiaries please sign both forms and non-Medicare patients need sign only the Financial Policy form) and forward them to us.
B. The office schedule will be altered as of 10/1/26 (if you already have a visit scheduled, we will contact your regarding any timing changes).
D. My dedication to you, your health care, and to the practice of
Integrative Cardiology will continue.

If you need to take a different direction:
A. Let us know so that I can organize a records package for your next physician (like I do when you go out-of-town for the winter).  Please don’t wait until the last minute
     (organizing your records will take me some time).
B. We can give you names of Primary Care Providers in SE Michigan who share our enthusiasm for Integrative Medicine, an Integrative Cardiologist in SW Michigan (who takes Insurance but not Medicare), and the names of two local Invasive Cardiologists and one EP Cardiologist, whom I respect, and who, while not of the Integrative mind-set, are not against it.
C. The heartfixer.com website (chock full of science and general recommendations) remains open to you.           
                                                                                                                                               
                                                                                                                                      Sincerely, James C. Roberts MD, FACC, FAARFM   7/15/26                                                                                                                                                                              

                                                                          Medicare Beneficiary Acknowledgement Form
 

This agreement is between Dr. James C Roberts MD (“Physician”), and ___________________ (“Patient”), who is a Medicare Part B beneficiary seeking services covered under Medicare Part B pursuant to Section 4507 of the Balanced Budget Act of 1997. The Physician has informed Patient that Physician has opted out of the Medicare program. The expected or known effective date and expected or known expiration date of the current opt-out period is 10-1-2026 (effective date) and 9-30-2028 (expiration date). The Physician’s opt out status auto-renews every two years unless terminated prior to the renewal date.

The Physician is not excluded from participating in Medicare Part B under Sections 1128, 1156, or 1892 or any other section of the Social Security Act.

Physician agrees to provide the medical services to Patient (the “Services”) listed on the Medical Fee Schedule:

In exchange for the Services, the Patient agrees to make payments to Physician pursuant to the Attached Fee Schedule.
Patient also agrees, understands and expressly acknowledges the following:

·        Patient agrees not to submit a claim (or to request that Physician submit a claim) to the Medicare program with respect to the Services, even if covered by Medicare Part B.

·        Patient is not currently in an emergency or urgent health care situation.

·        Patient acknowledges that neither Medicare’s fee limitations nor any other Medicare reimbursement regulations apply to charges for the Services.

·        Patient acknowledges that Medi-Gap plans will not provide payment or reimbursement for the Services because payment is not made under the Medicare program, and other
    supplemental insurance plans may likewise deny reimbursement.

·        Patient acknowledges that he has a right, as a Medicare beneficiary, to obtain Medicare-covered items and services from physicians and practitioners who have not opted-out of Medicare,
    and that the patient is not compelled to enter into private contracts that apply to other Medicare-covered services furnished by other physicians or practitioners who have not opted-out.

·        Patient agrees to be responsible, whether through insurance or otherwise, to make payment in full for the Services, and acknowledges that Physician will not submit a Medicare claim for
     the Services and that no Medicare reimbursement will be provided.

·        Patient understands that Medicare payment will not be made for any items or services furnished by the physician that would have otherwise been covered by Medicare if there were no
    private contract and a proper Medicare claim were submitted.

·        Patient agrees to reimburse Physician for any costs and reasonable attorneys’ fees that result from violation of this Agreement by Patient or his beneficiaries.]

Patient ________________________________________________  Date ___________

Physician _____________________________________________   Date ____________

                                                                                               Financial Policy

As a result of our sincere desire to base all medical decisions on what is best for the patient, not what is best for the insurance company, we are no longer contracted with any insurance carriers.

1. All charges must be paid at the time of service and our treatment fees are the same for all patients, regardless of insurance coverage or not, as is required by law.

2. The contract with your insurance company to pay for a portion of your medical care is between you and your insurance company. By eliminating costs associated with billing, coding diagnoses and procedures, referrals, authorizations, payment delays, EOB reviews, claim denials, re-submissions, collection risks, and other managed care costs, we can provide patients a fair price for services without the administrative hassles and bureaucracy.

3. For your benefit, we will always provide you with a list of our fees before any services are performed. We recommend you contact your insurance carrier to verify your benefits so you will have a basic understanding of how your insurance will reimburse you for services provided by our office. Unfortunately, insurance carriers are not always willing to provide their allowable fees or disclose which billing codes they will cover.

4. It is your responsibility to obtain all referrals/authorizations required by your insurance plan and to file your claim with your referral/authorization.

5. You will be given a completed Super Bill for you to file a claim with your insurance carrier. We recommend you contact your insurance carrier and request instructions for filing your claims.

6. Due to rising administrative costs and the numerous requests we receive, our office does not fill out “forms” from insurance companies.

7. Please Note: We do not charge interest, therefore, we are unable to offer in-house financing or payment plans. If you are unable to pay for your services in full with cash, check or money order, you may put the balance on your credit card and make monthly payments to your credit card company.

 8. Our clinic is state-of-the-art and our entire staff is exceptional. Our service is superb. Nothing about our practice is “usual” or “customary” – terms employed to justify the comparison of our fees, designed to provide for complex medical diagnosis and treatment with superior equipment, to those allowed by outdated insurance fee schedules.

9. Medicare:  Dr. Roberts has chosen to “Opt Out” of Medicare. All patients who are on Medicare, or are eligible for Medicare, must sign the federally mandated “Private Contract” in order to receive services at our clinic. All services must be paid at the time of service and neither Dr. Roberts nor the patient may file a claim to Medicare for reimbursement.

11. Medicaid:  We are not accepting any Medicaid patients. We will only accept “Private Pay” patients. We will not file any claims to Medicaid for reimbursement of your medical services now or at any time in the future.

12. Champus/Tricare: We are not an active Champus/Tricare/Tricare for Life provider. We will NOT accept Champus/Tricare/Tricare for Life insurance, we will NOT file any claims to Champus/Tricare/Tricare for Life and we will NOT accept the Champus/Tricare/Tricare for Life fee schedule for reimbursement of our services.

ALL charges for attorney cases, workers compensation cases, accident and/or injury cases must be paid in full, in advance, no exceptions. We will not file any claims for insurance benefits/reimbursement and we will not provide any discounts/write-offs for insurance or workers compensation plans. By signing this document, you are agreeing to pay for our services in full and forego any insurance benefits/discounts.

I have read, understand and agree to the terms and conditions listed above.

Patient Name ________________________________________ Date____________

                                                                                                       Fee Schedule

                                                                                                                                                 (10/1 through 12/3126)

        Dr. Roberts will review your chart and interval test reports, and update your records, well before your visit.  Post-visit he will dictate the visit and you will be provided with written instructions with respect to treatment changes and follow-up testing. In most cases, the dictation will be forwarded to you and to your other practioners (if you request) along with copies of pertinent testing. Compensation for these services is included in the visit fees. Please note that the estimated in-office times includes time for Dr. Roberts to dictate the visit.

IV Treatment Fees