To my treasured patients,

As of April 1st, 2022, I have elected to opt out of Medicare. This was a very difficult decision for me
and was made only after careful thought and consideration.

Over the course of my career, Medicare reimbursement has steadily declined while the cost of
running my practice has increased exponentially, to the point that continuing on this trajectory is
unsustainable.

Medicare Beneficiaries, as well as Medicare Advantage participants, will need to engage in a private
contract with me, prior to receiving treatment. My services will not be covered by Medicare. Please
note that this change only applies to physician services. All other costs including physical therapy,
hospital charges, implant costs, and anesthesia services will still be covered by Medicare.

I will provide a fee schedule to make this process clear and straightforward for all Medicare
beneficiaries electing to have me provide orthopedic knee services. Fees will include the
consultation, the surgical intervention, and a year of professional follow-up services.

I understand that this may affect some of my existing patients and their treatment schedules,
and regret if this impacts anyone negatively. For this reason, patients that are already scheduled or
have been seeing me and delaying surgery will have a discounted rate for the month of April.

As of this time, all other doctors and providers at Orthopedic Sports Institute will continue to accept
Medicare reimbursement as usual.

If you have any other questions regarding these changes, please do not hesitate to contact our
office.

Sincerely,
Dr. Jeffrey Lyman, M.D.