Payment and Billing Consent
Last Updated: November 13, 2024
By clicking where indicated, I, the undersigned, hereby agree to the terms described in this Payment and Billing Consent Agreement (“Agreement”).
This includes, but is not limited to, (i) my responsibility for payments if my health insurance plan does not cover the charges, (ii) the process of submitting claims to any Plan (defined below), (iii) the requirements for obtaining referrals, and (iv) the consequences of non-payment, including collection actions and associated fees.
Capitalized terms not otherwise defined in this Agreement have the same meaning as set forth in Found’s Terms and Conditions (“Terms and Conditions”), which are incorporated herein by reference.
1. Assignment of Benefits
By clicking where indicated, I, the undersigned, irrevocably assign to Pippen Health of Delaware, P.A., Pippen Health of California, P.C., Pippen Health of Texas, P.A., Pippen Health of New Jersey, P.A. (“Pippen Medical Group”), Cloud Health Medical Group, P.A., Cloud Health Medical Group of California, P.C., Cloud Health Medical Group of New Jersey, P.A., Cloud Health Medical Group of Kansas, P.C. (“Cloud Medical Group”), and other affiliated medical groups with which Found Health, Inc. may contract (collectively, “Medical Groups”) and any Medical Group’s engaged providers, including, but not limited to, doctors, nurse practitioners, and physician assistants assigned to me by Found Health, Inc. (collectively, “Providers”), all of my rights and benefits and any other interests I have in any medical insurance plan, health benefit plan, indemnify plan, trust, fund, or other source of payment for healthcare services (each, a “Plan”) in connection with medical services provided by Medical Groups and their respective Providers, employees and agents. I request and hereby agree that any benefits due me for my treatment by any Plan shall be paid or assigned to the applicable Medical Group. This includes any insurance company settlements related to my treatment. If my Plan will not pay the Medical Group directly for my care and treatment, I will immediately forward payments I receive to the Medical Group. I understand and agree that submission of charges to my Plan does not waive any Medical Group’s right to seek payment directly from me. I agree Medical Group may bill me for any charges due.
2. Contracted Plans
I understand and agree it is my responsibility to understand my Plan benefits. If I have questions about my health insurance coverage or charges, I am responsible for asking them before products or services are provided. I understand and agree, except as provided in this Agreement or the Terms and Conditions, neither Found Health, Inc., nor Medical Groups, Providers, Labs, or Pharmacies make any representations whatsoever that any fees are covered by my Plan.
If and where I receive Services from Cloud Medical Group, and I am a federal health program beneficiary, I agree that neither myself, nor my Provider, nor Cloud Medical Group will submit a claim for reimbursement to any federal or state healthcare program for the costs of the services and products provided to you through the Services.
3. Non-Covered Services
I understand that my Plan may not cover all my costs. Non-Covered Services shall refer to products or services provided by Medical Groups, Providers, Labs, or Pharmacies that are not covered by my Plan and are not considered a covered benefit under my Plan (“Non-Covered Services”). If any Medical Group, Provider, Lab, or Pharmacy does not participate in my Plan, or if my Plan does not cover the charges for my services, whether in full or in part, I understand and agree I will be financially responsible for any portion of the bill not covered by my Plan.
I agree to be personally responsible for any costs not covered by my Plan or that exceed my benefit limits, including, but not limited to:
(i) self-administered medications (medicines I would normally take on my own);
(ii) certain durable medical equipment;
(iii) certain medical supplies;
(iv) certain Non-Covered Services described in this Agreement; or
(v) services and supplies that my Plan determines are experimental or investigational or are not covered for some other reason, or that are not medically necessary but that I want to receive.
I understand and agree it is my responsibility to understand my Plan benefits. If I have any questions about my Plan coverage or charges, I am responsible for asking them before products or services are provided. I understand that, if my Plan requires a referral, I am responsible for obtaining one prior to my appointment.
I understand, except as provided in this Agreement or the Terms and Conditions, neither Found Health, Inc. nor Medical Groups, Providers, or Labs make any representations whatsoever that any fees are or are not covered by my Plan. Submission of charges to my Plan does not waive any Medical Group’s right to seek payment directly from me. Where applicable, I understand and agree that I—or the person signing or guaranteeing payment for me (“Guarantor”)—am responsible for any charges not covered by my Plan, for any reason.
4. Co-payments and Deductibles
I understand and agree, if my health insurance plan requires me to pay a deductible, co-payment or co-insurance for my healthcare services, the usual cost-sharing rules will apply (i.e., I will pay fees until my insurance covers costs (deductible), a fixed fee for specific services (co-payment), and a percentage of costs after meeting the deductible (co-insurance), where applicable and according to my individual Plan. I agree to pay for all co-payments and deductibles at the time of service. I understand co-insurance amounts and any other remaining charges will be billed to me. I agree to pay co-insurance amounts and other charges immediately upon receipt of a bill. I also agree Medical Groups may also ask me to pay for products and services in full in advance, unless Medical Group agrees with my Plan not to do this.
5. Subscription Fee
I understand and agree that any Found subscription fee is not a covered benefit under any health insurance plan and shall be considered a Non-Covered Service. My Plan will not be responsible for payment of the subscription fee nor any other Non-Covered Service(s). I understand and agree that I will be financially responsible for the subscription fee in whole. By purchasing a Found subscription, I agree to the payment terms as outlined in the Terms and Conditions and the offer terms presented during the checkout process. I understand that I may cancel my Found subscription in accordance with the Terms and Conditions.
6. Compounded GLP-1s
If I am prescribed and choose to purchase compounded GLP-1 medications through the Platform, I understand and agree that any charges and fees related to such compounded GLP-1 medications are Non-Covered Services and my health insurance plan will not be responsible for payment of any such charges or fees. I understand and agree that I will be solely financially responsible for all charges and fees for compounded GLP-1 medications and I agree that I will not submit, nor cause any other party to submit a claim to my health insurance plan for such amounts. I understand that I may contact Medical Group at any time at [email protected] if I no longer agree to be financially responsible for charges and fees for compounded GLP-1 medications. However, if I do not agree to be financially responsible for compounded GLP-1 medications, the third-party Pharmacy will no longer provide compounded GLP-1 medications to me. Please refer to Section 9 of the Terms and Conditions for additional details regarding prescription products.
7. Laboratory Services
From time to time, Found may present me with a choice of certain laboratory services and their costs. By purchasing such laboratory services, I agree to pay Found’s preferred Lab vendor for their services. If I choose to purchase laboratory services on a self-pay cash basis instead of utilizing my health insurance benefits. If I choose to self-pay for my laboratory services, I understand and agree that Medical Group will treat my purchase of these services as if I am an uninsured patient and I agree to be solely responsible for full payment of the listed price of the services and neither I nor Medical Groups nor any third-party Labs, Pharmacies or Providers will submit any claim to any insurance plan for the services. The listed price of laboratory services includes amounts paid to third-party Labs and administrative fees paid to Found. Within a reasonable timeframe following Medical Group’s receipt of the results of your diagnostic labs, a Provider will review the results with you and answer any questions you may have.
8. Self-Pay Options
If I do not have health insurance coverage, or if any Medical Group, Lab or Pharmacy provides any product(s) or service(s) to me and does not participate in my health insurance plan, or if I choose to self-pay for any product(s) or service(s) for any reason, whether or not I have health insurance coverage, I agree to pay such Medical Group, Lab, or Pharmacy all applicable charges at the prices then in effect for the products or services provided to me, including any no-show fees where applicable In accordance with the Terms and Conditions, I hereby authorize Found to automatically charge my payment method for all such charges. If my payment method is invalid at the time payment is due, I agree to pay all amounts due upon demand. Please refer to the Terms and Conditions for additional details.
9. Payment and Collections
Found and Medical Groups accept credit and debit cards issued by U.S. banks. If a credit card account is being used for a transaction, Found and the Medical Groups may obtain preapproval for an amount up to the amount of the payment. If I enroll to make recurring payments automatically, all charges and fees will be billed to the credit card I designate during the setup process. If I want to designate a different credit card or if there is a change in my credit card, I understand that I must change my information online. This may temporarily delay my ability to make online payments while Found verifies my new payment information.
I hereby authorize the Medical Group or its designated agent to access my consumer credit report to help collect what I owe or to see if I am eligible for financial aid or charity care. In the event any collection action is necessary to collect amounts I owe to a Medical Group, Lab and/or Pharmacy, I agree to pay all expenses associated with such action, including but not limited to collection agency fees and attorneys’ fees.
Where permitted by law, Medical Group and its providers, affiliates, agents and contractors, including debt collectors, may call or text my cell or home phone using any type of artificial or pre-recorded voice or auto-dialer technology for any purpose, including billing and collections.
Found reserves the right to charge any outstanding post-claim balances to the payment method on file. An invoice will be provided post-claim, with payment due within 15 days, at which point if payment has not been made yet, the card on file will be billed. If payment is unsuccessful, you will have an additional 30 days to resolve the balance before your subscription is terminated pursuant to the Terms of Service. Notification, where provided, is for your convenience and does not constitute an obligation on Found’s part. You agree that any post-claim balances due will be processed automatically, unless you contact Found’s support team to address any outstanding payment concerns prior to processing.
You also agree to be responsible for a fee of thirty dollars (USD $30.00) (“No-Show Fee”) for any scheduled consultation for which you fail to attend or cancel upon less than 24-hours notice. This No-Show Fee shall be charged to the payment method on file.
10. Agreement
By agreeing to this Payment and Billing Consent Agreement, I hereby acknowledge and agree to all terms and requirements herein. I acknowledge that my digital signature or other indication of acceptance of this Agreement shall be considered as effective and valid as an original signature.
I acknowledge my financial responsibility for any portion of the bill not covered by my Plan and I authorize Found and Medical Groups and Providers to submit claims to my Plan on my behalf, where applicable. I also agree to pay any fees and costs associated with products or services that are not covered by my Plan, including those products or services that I choose to purchase on a self-pay cash basis. Furthermore, I consent to the use of my credit or debit card for payment transactions. I also authorize Medical Group and Provider and/or their agents to release any medical or other information about me in their possession to my Plan, federal and state administrative agency, or their intermediaries or fiscal agents required or requested in connection with processing any claim for services rendered to me by Provider.
I have read, understand, and agree to this Agreement.
