TERMS AND CONDITIONS OF PAYMENT
Receipt of health care services from Amazing Meds and an Amazing Meds Provider and your use of the Amazing Medicines, LLC Internet Platform (the “Platform”) in connection with such health care services, constitutes an ongoing agreement to these Terms and Conditions of Payment (the “Terms and Conditions”). Capitalized terms used herein but not otherwise defined shall have the meaning given to such terms in the above Health Care Services Consent.
YOUR RESPONSIBILITY FOR PAYMENT
I understand and acknowledge that Amazing Meds from whom I receive care and the pharmacies that receive prescriptions from such Amazing Meds per the Platform, are not paid or reimbursed by managed care plans, Medicare, Medicaid, or other government healthcare programs, or other third-party payors. If Amazing Meds does not accept my insurance plan, I acknowledge that I will be asked to sign an ABN (Advanced Beneficiary Notice) for non-covered services, medications, and labs. Except as otherwise explicitly stated herein, I will be billed directly and shall be personally responsible for payment, regardless of whether I am or will be reimbursed by a managed care plan or other third-party payer.
I agree to make timely payments for all health care, laboratory, and pharmacy services that are provided to me. I understand by providing my payment information on the Platform, including but not limited to any credit card information or credit card hold information for future payments, I authorize Amazing Medicines, LLC to charge the credit card or other payment method for all items and/or services I receive or are scheduled to receive from the Amazing Meds Provider providing my care, the laboratories, and the pharmacies. I understand when I receive services from Amazing Meds, the cost of services (including medical care, laboratory, and prescription costs remitted directly to the laboratories and pharmacy on my behalf) is calculated and services are provided on an agreed-upon basis, and I will be billed for payment (even if I do not receive medical services or prescriptions in more than one month of the plan for which I am billed). I understand I have the choice to pay for my program cost upfront, in-full for the year (at significant savings), or in monthly, or every other month payments. I understand I am responsible if I cancel before my agreed-upon program is completed, for a prorated cost of my program even if I discontinue as a patient before completing payment monthly or every other month plan I’ve agreed to. I understand that the cost of services, including labs, medications, are final and not refundable. This is because the cost of treatment is for professional medical services (including any blood draws) which are fully rendered at the point of care. Pharmacy rules prohibit the return of medications for reimbursement because medications are packaged for you and cannot be used for another patient. I understand I will not be able to receive refunds for treatments and for medications, even if they are unused. I understand that Amazing Meds reserves the right to discontinue service if I am delinquent on any payments, for which I am responsible.
I understand and agree to provide a 30-day notice prior to stopping treatment. I agree to have a final visit with an Amazing Meds Provider, in order to safely discontinue use of the medications used in my treatment plan.
MISCELLANEOUS
Any and all controversies, claims, or disputes arising out of, relating to, or resulting from these Terms and Conditions of Payment shall be subject to the arbitration provisions as set forth in the Terms & Conditions at amazing-meds.com. The provisions of these Terms and Conditions of Payment shall be severable, and if any provisions shall be prohibited by law, invalid, or unenforceable in whole or in part for any reason, the remaining provisions shall remain in full force and effect. The virtual consultation will be recorded by the provider to ensure protection and accuracy with HIPAA compliance and company policies.
I understand that by signing this form, I am agreeing to the foregoing Health Care Services Consent and Terms and Conditions of Payment.