Agreement between the patient and a doctor, podiatrist, dentist, or optometrist who has decided not to offer services through the Medicare program. This doctor cannot bill Medicare for any service or supplies given to the patient and all his or her other Medicare patients for at least 2 years. There are no limits on what the patient can be charged for the services under a private contract. The patient must pay the full amount of the bill and submit his or her own insurance claims for reimbursement. The GJ modifier must be used on all insurance claims for services rendered by an “opt out” provider for emergency/urgent services.