Dr. Donald Roberts – Changes to Medicare Contracting Starting April 2025
Please note an important update in my practice. As of April 1, 2025, I will no longer be contracted with Medicare. This means that if you are enrolled in Medicare Part B or a Medicare Advantage plan, I will need to establish an individual contract with you to continue providing your medical or surgical care.
Since I started at Rebound nearly 40 years ago, my goal has always been to provide exceptional patient care and to do it in a timely manner. Unfortunately, due to several government-driven factors, I have been forced to reevaluate my practice.
I understand that this change in my practice may create challenges for you, and please know this decision was not made lightly. However, by stepping away from Medicare, I will be able to see patients who have Medicare insurance more quickly without the long wait times I have had in the past. I will also be able to schedule surgery more quickly and will be able to provide a better and more personalized experience around knee surgery.
Can I still see you if I have Medicare insurance?
Yes, I will still see Medicare patients. However, I will no longer be able to bill Medicare directly. Instead, we will work together under an individual contract, which will require some out-of-pocket costs.
What about a letter from my insurance stating I need to see another provider?
You may have received a letter from your insurance company indicating I am no longer able to see you. To clarify, I can and will still see Medicare patients. However, I will no longer be able to bill Medicare directly. Instead, we will work together under an individual contract, which will require some out-of-pocket costs.
What will this mean for your out-of-pocket costs?
If you choose to continue your care with me, there will be out-of-pocket expenses. For example:
- An initial evaluation with X-ray will cost $320.
- A follow-up visit with an X-ray will cost $175.
- An arthroscopic meniscus surgery will cost about $1,400.
- A total knee replacement, including 90 days of follow-up care, will be $4,000. This includes the assistant fee.
Please note that Medicare will still cover all the other bills associated with your surgical care, including hospital fees, lab tests, nursing care, physical therapy, and more.
Can I still see you for emergencies?
Yes. Medicare guidelines still allow me to provide emergency services.
What if I’m not enrolled in Medicare Part B?
If you are not enrolled in Medicare Part B or have private insurance, this change does not apply to you, and your coverage remains the same.
Are other physicians at Rebound still contracted with Medicare?
Yes, all other physicians at Rebound remain contracted with Medicare and will continue to offer the high-quality care you’ve come to expect. This change applies only to my practice. My physician assistant, Kyle I. Pirtle, P.A.-C., is still contracted with Medicare.
I want to emphasize that my commitment to your health and well-being remains unchanged. I am happy to discuss this further and help guide you through your options.
For more information or questions about this change, please call (503) 635-7335. If you would like to request an appointment with Dr. Roberts, please use the button below.