Welcome to Heddle Health!

We are a direct-pay healthcare provider and do not bill or accept payment from any private health insurance plans, Medicare, Medicaid, or any other government healthcare program. This approach allows us to focus entirely on your care, without the administrative constraints of insurance requirements.

1.Understanding of Direct-Pay Model

• No Insurance Billing: I understand and agree that Heddle Health will not submit claims to any health insurance provider, including Medicare, Medicaid, or other government programs, for services rendered.
• Patient Financial Responsibility: I accept full and sole financial responsibility for the cost of all services provided by Heddle Health.
• No Reimbursement Guarantees: I understand that any payments I make to Heddle Health may not be eligible for reimbursement from my health insurance plan and may not count toward my deductible or out-of-pocket maximum.

2.Voluntary Participation

• Informed Choice: I confirm that I am enrolling in this service voluntarily, understanding that I have other options for receiving healthcare services.
• Not a Health Plan: Heddle Health offers healthcare services directly to members in exchange for payment of membership fees and service charges as described in this Membership and Financial Responsibility Agreement and other terms and conditions that may be presented to you from time to time.
  
  I acknowledge that this agreement is for specific healthcare services and is not a substitute for health insurance. I have been advised to maintain a separate health insurance policy to cover healthcare costs outside the scope of this agreement, including hospitalizations, emergency care, or specialty consultations.

3.Medicare Beneficiary Acknowledgement

• Provider Opt-Out Status: I acknowledge that Heddle Health is a provider that has formally "opted out" of the Medicare program.
• Private Contract: I understand that because my Heddle Health has opted out of Medicare, I am entering into a private contract for all services and agree not to submit claims to Medicare or ask Heddle Health to do so.
• Patient Right to Choose: I acknowledge that I have the right to seek care from a Medicare-participating provider for Medicare-covered services and am voluntarily choosing to receive and pay for services from this opt-out provider.

4.Online Telehealth Services Consent

• Telehealth Limitations: I understand that online telehealth services may not provide the same experience as in-person visits. I accept that there are potential risks, such as technological failures or interruptions in the audio-video connection.
• Emergency Acknowledgment: I agree that in the event of a medical emergency, I will not rely on Heddle Health's online services and will instead call 911 immediately or go to the nearest emergency room.

5.Patient Information and Communication¹

• Patient Responsibilities: I agree to provide accurate and updated information to the practice and to inform the provider of my health history and needs.
• HIPAA and Privacy: I understand that my medical information will be protected in accordance with federal HIPAA regulations and Heddle Health's HIPAA Notice of Privacy Practices.
• Communication Consent: By signing, I consent to receive appointment reminders and other communications via my provided email and/or phone number.

6.Fee Structure and Payment²

• One-time Initial Consultation Fee: I understand that a one-time, non-refundable initial consultation fee of $10 per person will be charged upon completing my registration.
• Per-Visit Fee: I understand and agree that an additional fee of $10 per person will be charged for each online visit, regardless of the duration or complexity of the visit. I further understand and agree that I will be charged $5 for each generic medicine prescribed and received through Heddle Health, and I accept responsibility for timely payment.
• Credit Card Authorization: I authorize Heddle Health to charge my provided credit card $10 for each online visit and $5 for each generic medicine fulfilled by Heddle Health.
• Member Financial Responsibility: I acknowledge I am solely responsible for all fees and charges incurred for services provided by or through Heddle health. I agree to pay all amounts due at the time of service, unless other arrangements are made in advance and confirmed in writing by Heddle Health.

7.Termination of Agreement

• Termination Clause: I understand that both the patient and Heddle Health can terminate this agreement at any time by providing written notice.

8.Limitation of Liability

• Termination Clause: Heddle Health’s liability for any claim arising out of this Agreement or the provision of services is limited to the amount of fees you have paid for the relevant service.

¹ NTD: note specific California telehealth informed consent clause and medical debt disclosure.

² NTD: this may not qualify as a DPC arrangement in Texas, but it may be permissible as an episodic telehealth private contract. If we want to qualify under Texas DPC, we could use a $10 initial fee plus a monthly recurring fee, but that would appear to destroy the economics.