OB/GYN practice transition letter & Medicare opt-out private contract generator

01What a practice transition letter must cover

A transition letter has one job: make sure no patient is left without care because your business model changed. Medical boards treat ending or changing a physician–patient relationship without reasonable notice and help with transfer as a possible form of patient abandonment. Exact expectations vary by state and are not listed here, but the letters that hold up share the same parts, and the generator prints them in this order:

1. What is changing and when. The effective date, your new care model and the new practice’s name, address and phone number.
2. Care until and after the effective date. Patients can keep their visits under current insurance until the date, and your office keeps answering urgent questions and moving records for a set window afterwards (30, 60 or 90 days).
3. Emergency instructions. A plain line telling patients to call 911 or go to the nearest emergency department.
4. Prescriptions. Your bridge-refill policy, for example one 90-day refill for stable hormone, contraceptive and thyroid prescriptions.
5. Pregnancy and high-risk patients. If you are dropping obstetrics, name the covering group so prenatal care continues without a gap.
6. Records. Who the records custodian is, how to request a transfer and that sending copies to the new clinician costs nothing.
7. How to find an in-network clinician. The insurer’s member services line and provider directory, and the county medical society.
8. An invitation, if you want one. A short paragraph for patients who want to follow you, with your fees stated plainly.

Patients who will transfer out need a records release to move their chart; point them to the free HIPAA records release generator, which builds one with every required element.

02Notice timeline: payer contracts, patients and your own records

Plan the transition backwards from the effective date. Three clocks run at once, and the longest one sets your start:

• Payer contracts. Most participation agreements set a written notice period for leaving the network, and some require you to keep treating certain patients for a time afterwards. Read the termination clause of each contract before you choose a date.
• Patient notice. Notice periods for patients vary by state, medical board guidance and payer contract. The generator warns you when the effective date is less than 30 days after the letter date; many practices give considerably more, and patients in active treatment need the most time.
• Continuity-of-care protections. Federal No Surprises Act rules can let a continuing-care patient, such as someone who is pregnant or in active treatment for a serious condition, keep in-network cost-sharing for up to 90 days after a clinician leaves a plan’s network. The plan handles that notice, but your letter should not contradict it.

Keep a dated copy of every letter and a list of who it was sent to, by mail or portal. That record is your evidence of notice if a patient or board asks later. Tell your malpractice carrier and your staff before the letters go out, so the front desk gives patients the same answers the letter does.

Before you announce anything, check that the numbers work. The practice transition simulator models a 300-member panel at $200 a month with obstetrics dropped, so you can see how many patients you need to keep. The OB/GYN practice transition blueprint lays out the full sequence, from payer exits and malpractice changes to the first membership agreement.

03When you need a Medicare opt-out private contract

Many patients over 65, and some younger patients on disability, have Medicare. A clinician who stays enrolled in Medicare generally cannot simply charge a Medicare beneficiary cash for Medicare-covered services. To bill a Medicare patient privately for those services, a physician or an eligible practitioner (which includes nurse practitioners and certified nurse-midwives) must opt out of Medicare and sign a private contract with each Medicare patient.

Opting out has two separate pieces:

1. The opt-out affidavit, which you file with your Medicare Administrative Contractor. It covers all Medicare patients, not one.
2. A private contract with each beneficiary, signed by both of you before you furnish any items or services under it, and not signed while the patient needs emergency or urgent care. This generator drafts the contract; it does not file the affidavit.

Under 42 CFR § 405.405, opt-out periods run 2 years. The generator sets the contract’s expiration to the end of the 2-year period that starts on your opt-out effective date, and § 405.415(o) requires a contract for each opt-out period. Ask your contractor how renewal and cancellation work for your dates.

Patients who pay you directly, whether under a private contract or as self-pay patients, may also be entitled to a written estimate of charges. The Good Faith Estimate generator builds one with every element of 45 CFR § 149.610.

04Every § 405.415 requirement on the contract

42 CFR § 405.415 lists what a private contract must be and say. The contract this tool prints covers each paragraph, labeled with its letter so a reviewer can check it quickly:

Table 1 · Paragraph letters as published in 42 CFR § 405.415, checked 2026-11-10.

Your fee schedule is referenced in the payment clause; attach it to the contract. If a legal representative signs for the beneficiary, record their name and relationship in the signature block. Give the beneficiary a copy before the first service, keep the original with both signatures for the whole opt-out period, and file it where you can produce it quickly if CMS asks.

05How to use this generator

1. Pick the document: the patient letter (A), the Medicare private contract (B), or both as one packet (C).
2. Enter your practice details, your NPI, the letter date and the effective date. The tool warns you if notice is under 30 days or the effective date comes before the letter.
3. Set the safeguards: the urgent-question window, your refill policy, the records custodian and, if you are dropping obstetrics, the covering group.
4. For Medicare patients, add the beneficiary name, your opt-out dates and your exclusion status. Print one contract per beneficiary.
5. Have counsel review the letter and the contract before use, then mail the letters and keep a dated copy of each.

Send the letter to every patient seen in a reasonable look-back period, not only those with upcoming visits, and post the same notice in the office and on the patient portal. Patients who call after reading it should hear the same dates and options from your staff.

To send the letter in bulk, paste the final text into your EHR’s letter template or patient portal; the Hint vs Cerbo vs Elation comparison covers which systems handle membership billing and patient messaging. If you plan to give PPO patients a superbill, the out-of-network superbill generator builds one.

Prefer to write by hand? Click Clear All Fields and print: every field prints as a blank line. These are educational templates, not government forms, and they cannot guarantee that a notice or contract is valid.

This page is educational and is not medical or legal advice; review every document with healthcare counsel licensed in your state.