LEGAL DISCLAIMER FOR PATIENTS ENROLLED IN GOVERNMENT HEALTH PLANS
By choosing to receive our services and/or purchase our device, you acknowledge and agree to the following:
- Out-of-Pocket Service. The services and/or devices provided to you are offered solely on a self-pay, out-of-pocket basis. The services and/or devices are not covered by, and will not be billed to, any federal or state government health insurance program, including but not limited to Medicare, Medicare Advantage, Medicaid, TRICARE, or any similar plan (collectively referred to as “Government Health Plans”).
- No Reimbursement. You understand and agree that these services and/or devices are not covered by Government Health Plans. You further agree that you will not seek reimbursement for these services or/or devices from any Government Health Plan, nor will you submit any claim for such reimbursement, directly or indirectly.
- Voluntary Agreement. You are voluntarily electing to receive and pay for these services and/or devices knowing that they are not covered benefits under your Government Health Plan. You are not required or obligated to purchase our services or our products. You understand that your participation in this transaction is not a condition of enrollment in or eligibility for any Government Health Plan.
- Confirmation of Understanding. By proceeding with payment for these services and/or devices, you confirm that you understand this disclaimer, and that you knowingly and voluntarily agree to these terms. You further acknowledge that no representation has been made to you that these items or services will be reimbursed by any Government Health Plan.
If you do not agree to the terms above, you should not proceed with the service or purchase.