This Patient Services Agreement governs the relationship between Inspire Health Direct Primary Care, LLC and patients who subscribe to our monthly service. 

 

Terms and conditions

 

 I understand and agree that I am voluntarily subscribing to Inspire Health Direct Primary Care, LLC and that this agreement is non-transferable. 

I have reviewed the list of covered services available at www.inspirehealthdpc.com, and I have had the opportunity to ask questions and receive answers regarding its content.

I understand and agree that Inspire Health Direct Primary Care, LLC does not provide health insurance coverage.  This agreement is not a contract for health insurance. I understand that Inspire Health Direct Primary Care, LLC only provides primary health care and limited urgent health care services to clients who maintain their account in good standing. Inspire Health Direct Primary Care, LLC encourages all patients to obtain healthcare insurance to cover events such as hospitalization, surgery, emergency room visits, and other serious health events and all health care services provided outside of Inspire Health Direct Primary Care, LLC. 

I understand and agree that Inspire Health Direct Primary Care, LLC will not bill insurance carriers for any services provided by Inspire Health Direct Primary Care, LLC.  I assume sole financial responsibility for any and all covered services furnished by Inspire Health Direct Primary Care, LLC and its personnel under this agreement. 

I understand and agree that Inspire Health Direct Primary Care, LLC healthcare providers have sole discretion to determine which services are medically appropriate to meet patient needs.  I understand that if a provider of Inspire Health Direct Primary Care, LLC determines that I require treatment beyond what is offered at Inspire Health Direct Primary Care, LLC, such as treatment by a specialist or emergency room care, then such treatment will not be provided by Inspire Health Direct Primary Care, LLC. 

I understand and agree I am responsible for charges incurred for health care services performed outside of Inspire Health Direct Primary Care, LLC, including but not limited to emergency room services, hospitalization, speciality services, or any medical transportation. 

I understand and agree that I can cancel my Inspire Health Direct Primary Care, LLC subscription at any time by submitting a written cancellation notice to Inspire Health Direct Primary Care, LLC at least five days before the due date of my next monthly payment.  Monthly fees will continue to accrue until a written termination notice is received and processed.   In the event I cancel my subscription, any fees paid for the current month in which the request is received are non-refundable.  

I understand and agree that once my subscription is cancelled, Inspire Health Direct Primary Care, LLC will no longer coordinate my healthcare, including prescription refills, referrals, ordering diagnostic testing, or taking after hours calls. 

I understand and agree to pay my monthly subscription fee on or before its due date.  I understand that if I am unable to pay my fee on time, this agreement may be terminated.  Covered services may be withheld until outstanding fees have been paid.  If I let my account get more than 30 days past due, my subscription will be cancelled.  I understand that I may apply to have my account re-instated, however I must pay a re-instatement fee of $300.  I also understand, that in the event my subscription is cancelled for non-payment, Inspire Health Direct Primary Care, LLC has the right to refuse to accept my request for re-instatement. 

I understand and agree that although my access to Inspire Health Direct Primary Care, LLC is unlimited for illness or injury, Inspire Health Direct Primary Care,LLC providers will direct my follow up visits for treatment at such frequencies and durations as the providers deem are reasonable and appropriate under the circumstances  

I understand and agree that Inspire Health Direct Primary Care, LLC may terminate this Patient Agreement at any time without cause by providing me written notice.  

I understand and agree that Inspire Health Direct Primary Care, LLC may add or discontinue services or change the fee schedule for covered servicesat any time and I will be given at least thirty days written notice before such changes are implemented.  I understand and agree that the prices for labs and medications are subject to change without written notification and that all prices for prescriptions or labs are based on the cost to Inspire Health Direct Primary Care, LLC.  

I understand that upon thirty days prior written notice, Inspire Health Direct Primary Care, LLC may amend this agreement in order to comply with any local, state, or federal law or regulation adopted or implemented by any federal, state, or local government or agency, court or other third party which impacts the performance of this Agreement. 

I understand that if Inspire Health Direct Primary Care, LLC is unable to perform its duties under this Agreement due to labor disputes, governmental restrictions, fire or other casualty, emergency, electricity, utility or server outages, or any cause beyond the reasonable control of Inspire Health Direct Primary Care, LLC, performance will be excused for the duration of such event.  

I understand that if any one or more of the provisions of this Agreement is for any reason held to be invalid, illegal, or unenforceable by a state or federal regulatory agency or court of competent jurisdiction, the remaining provisions shall not be affected thereby, but shall remain in full force and effect. 

I understand that Inspire Health Direct Primary Care, LLC must maintain a record of my health informations and protect privacy of my health information.  I understand that I have the option to opt out of secure communication to utilize non-secure text messaging and email for communication between myself and Inspire Health Direct Primary Care, LLC. 

I understand and agree that Inspire Health Direct Primary Care, LLC providers will determine on a case-by-case basis whether or not to fulfill requests for short or long term disability determinations. 

I understand and agree that Inspire Health Direct Primary Care, LLC providers retain sole authority to administer long-term pain management.  Long term pain management will be subject to the medication policy found at www.inspirehealthdpc.com.