Notices to Patients

1) Medical doctors are licensed and regulated by the Medical Board of California.

To check the status of a license or to file a complaint, you may:

• Visit: www.mbc.ca.gov
• Email: licensecheck@mbc.ca.gov
• Call: (800) 633-2322

2) Open Payment Database

 “For informational purposes only, a link to the federal Centers for Medicare and Medicaid Services (CMS) Open Payments web page is provided here. The federal Physician Payments Sunshine Act requires that detailed information about payment and other payments of value worth over ten dollars ($10) from manufacturers of drugs, medical devices, and biologics to physicians and teaching hospitals be made available to the public.”

https://openpaymentsdata.cms.gov.

3) This notice is to inform you of important updates regarding our practice’s status with Medicare and how it affects your care:

Medicare Opt-Out Status:

• Both Dr. Sara Herman, MD and Dr. Natalia Carey, MD, as well as Soft Reboot Wellness (SRW), have opted out of Medicare. This means that:
  • Neither SRW, Dr. Herman, Dr. Carey, nor any Medicare beneficiary will submit claims to Medicare or receive any payment from Medicare for services provided.
  • Opted-out physicians and their patients are not eligible to receive payments under Medicare Advantage plans.

• Commercial Insurance:
  • If you are a patient with a commercial insurance plan, we can provide you with a superbill upon request. You may submit this superbill to your insurance provider for potential reimbursement.
  • Please note that reimbursement from your insurance provider is subject to their policies and your individual plan’s coverage.
• Payment Methods:
  • Payment for all services must be made at the time of service. We accept the following forms of payment:
    • Cash
    • Check
    • Credit Card

By signing below, you acknowledge that you have been informed of this update regarding our opt-out status from Medicare and that you understand the terms of payment and reimbursement as outlined.

Patient Acknowledgment:

I have read and understand that Dr. Sara Herman, MD, Dr. Natalia Carey, MD, and Soft Reboot Wellness have opted out of Medicare. I agree that no claims will be submitted to Medicare or Medicare Advantage plans for services provided. I understand that I am responsible for the full payment of services at the time they are rendered and that superbills are available upon request for submission to my commercial insurance plan.