help! how to opt out of Medicare and manage conflicting instructions?

[Guest guest]

Has anyone opted out of Medicare this summer, especially via Palmetto GBA which is California's Medicare carrier?I wanted to opt-out effective 7/1/12; I sent in the opt-out affadavit in late May, but now have gotten stuck because in early June they wrote to me requesting a signed contract with beneficiary...but of course I had no patients, since I had not yet opted-out and in fact had been planning to start trying to see patients in August. 

On the phone in June I was told ok to send a sample contract unsigned by beneficiary, however that was then rejected. They tell me on the phone my opt-out was denied, although I've never received the letter they claim they sent.

Every time I call, someone tells me something else. One person said of course I wouldn't be able to provide a contract signed by beneficiary and that the analyst was wrong to deny me, so he " escalated " my case and said it should be resolved in 7-10 days. 

When I called the enrollment center 2 weeks later, the person began to giggle on the phone and then apologized and said she's sorry but this is a weird catch-22 and they just don't know what to tell doctors about it, because you aren't allowed to see patients before you opt-out, but you can't opt out without a signed contract.

The next person (today) told me you are supposed to provide a signed contract within 10 days of the affadavit. She did not know how I am supposed to do that when they also require you to submit your affadavit 30 days before the start of the quarter. She thinks I will probably have to try to opt-out again, although it's unclear how to do that successfully.

Meanwhile the case is still " escalated, " which apparently means some department in which you can never call them.Today I took a good look at the regulations. One section does say " In order for a private contract with a beneficiary to be effective, the physician/practitioner must file an affidavit with all Medicare carriers to which the physician/practitioner would submit claims, advising that the physician/practitioner has opted out of Medicare. The affidavit must be filed within 10 days of entering into the first private contract with a Medicare beneficiary. "

Another section says " Participating physicians or practitioners may sign private contracts only after the effective date of affidavits filed in accordance with §40.9 " And then of course there is this " Participating physicians and practitioners may opt out if they file an affidavit that meets the criteria and which is received by the carrier at least 30 days before the first day of the next calendar quarter showing an effective date of the first day in that quarter (i.e., January 1, April 1, July 1,October 1). "

Does anyone have suggestions?? If I get a beneficiary to sign a contract this week and send it to them, will that reach the escalation people and resolve the issue?

thanks for any suggestions,

leslie-- Kernisan, MD MPHGeriatrics