Legal

Last Updated: February 17, 2025

1. Purpose and Scope

This BAT Test Terms of Service (“Terms”) outlines the BAT Testing protocols, including the Beta-Amyloid 42/40 Ratio (BA Test), Mechanism Panel (MP), Phosphorylated Tau 181 (T Test), and BAT Level Index (BLI) scoring system. It explains the methodology, scoring framework, and use of results within the BATWatch Protocol.

These Terms apply exclusively to BAT Testing services provided by Silver House Healthcare, LLC (“Silver House”). BATWatch is a program operated by Silver House to facilitate cognitive health screening and patient engagement. These Terms do not cover other services or treatments, which are outlined separately in the BATWatch Terms of Service.

2. Roles and Responsibilities

a) Silver House Healthcare, LLC (“Silver House”): The exclusive provider of all BAT Testing services, including test ordering, results analysis, and patient care. Silver House is responsible for all healthcare services provided under the BATWatch program.

b) BATWatch Program (“BATWatch”): A digital platform and patient engagement program operated by Silver House to support appointment scheduling, results delivery, and educational resources. BATWatch is not a healthcare provider. All medical decisions are made by Silver House or licensed providers affiliated with Silver House.

3. Data and Results Ownership

a) Data Custodian: Silver House maintains all medical records, including BAT Test results, in compliance with HIPAA and applicable state laws.

b) Results Access: BATWatch serves as a secure portal for accessing results, but Silver House retains sole authority over medical record management.

c) Data Sharing: Results may be shared with your designated healthcare provider and used by Silver House for quality improvement and research purposes, in accordance with our Privacy Policy.

d) Record Retention: Silver House retains your test results as required under federal and state healthcare recordkeeping laws.

4. Testing Limitations Disclaimer

a) For Informational Use Only: BAT Testing results are provided as clinical decision support tools and should be interpreted in conjunction with your healthcare provider’s medical judgment.

b) Not a Standalone Diagnosis: The BAT Level Index (BLI) scoring system identifies cognitive risk factors but is not a diagnosis of any condition.

c) No Treatment Decisions Without Consultation: Decisions regarding treatment or prevention strategies should only be made following a complete medical evaluation.

d) Test Variability Statement: Results may vary due to biological factors such as infections, medications, or recent illnesses. The BATWatch protocol addresses variability with multi-test validation.

5. Appeals and Re-Testing Policy

Silver House provides a structured process for addressing concerns regarding BAT Test results.

a) Eligibility for Re-Testing:

I. Borderline results requiring confirmatory testing per the BATWatch Protocol.

II. Laboratory error or sample contamination.

III. Physician-requested re-test based on new clinical information.

b) Re-Testing Process:

I. Requests must be submitted within 30 days of the initial results.

II. Re-tests follow the same multi-test protocol as the original test.

III. Results from re-testing will be provided within the standard reporting timeline.

c) Appeals Process for Insurance Denials:

I. Silver House will provide documentation supporting the medical necessity of BAT Testing, including pre-test risk scores and sequencing justifications.

II. Our team will assist with insurance appeals for denied coverage when the BATWatch protocol was followed.

6. Testing

While spinal fluid tests and brain scans are options, they’re expensive and invasive. The BATWatch Protocol takes a different approach, utilizing a simple, cost-effective blood test with a structured multi-test process to ensure accuracy and reliability.

Primary Tests in BATWatch Protocol:

a) Beta-Amyloid 42/40 Ratio (BA Test): Identifies abnormal beta-amyloid accumulation, the earliest marker of Alzheimer’s risk.

b) Mechanism Panel (MP): Conducted alongside the BA Test to detect underlying contributors such as inflammation, cardiovascular dysfunction, metabolic imbalances, and stress-related factors. These results help justify the necessity of Tau testing (T Test) for insurance approval and clinical assessment.

c) Phosphorylated Tau 181 (T Test): Ordered based on BA and MP findings to confirm whether neurodegeneration has begun.

5.1 Test Accuracy & Protocol Adaptability

No diagnostic test is perfect—but BATWatch compensates for inherent test variability through structured validation steps. By utilizing biomarker-specific thresholds, multi-test validation, and sequential testing logic, we significantly improve diagnostic confidence while addressing insurer concerns about test reliability.

5.2 How BATWatch Ensures Accuracy

Multiple-Test Strategy: Instead of relying on a single lab result, our protocol integrates parallel biomarker data and repeat testing when thresholds are borderline, ensuring more precise decision-making.

Example: If BA levels are borderline, we require a confirmatory test before moving forward with T Testing to rule out temporary fluctuations, such as MP.

This structured redundancy reduces misclassification risk, avoiding unnecessary treatments while ensuring high-risk patients receive timely intervention.

Statistical Validation: The BATWatch methodology ensures that cumulative test accuracy meets or exceeds 90% certainty, using well-documented statistical principles:

Minimum Sensitivity: ≥ X% (ensures accurate detection of at-risk patients).

Minimum Specificity: ≥ Y% (prevents false positives that could trigger unnecessary interventions).

Post-Validation Accuracy: ≥ 90% after multi-test refinement, ensuring a reliable basis for clinical action.

5.3 We Are Test-Agnostic

BATWatch does not depend on any single lab provider or proprietary test, ensuring that the protocol can integrate future advancements in BA and T Testing without disruption.

Test-Agnostic Strategy: As new tests emerge, the protocol can adopt them seamlessly while maintaining strict accuracy thresholds.

Accuracy: The structured double-testing approach compensates for variability in specificity and false rates across different BAT Tests, ensuring broad compatibility with future testing options. This allows for increased availability of competing tests, driving innovation, and lowering patient costs while maintaining diagnostic reliability.

Insurance Optimization: Ensures every test is justified based on existing biomarkers, improving approval rates for pre-authorizations.

Economic Neutrality: Avoids over-reliance on any single laboratory, prioritizing patient care over vendor partnerships.

5.4 Pre-Test Risk Stratification Prevents Unnecessary Testing

Insurance carriers prioritize “medical necessity” when approving biomarker-based screening.

Our risk-scoring framework pre-filters patients, ensuring only those with clinical justification receive further testing—reducing unnecessary costs while maximizing approval rates.

Real-World Insurer Considerations

Many insurers deny coverage based on statistical false rates in blood-based biomarker testing.

BATWatch solves for this by demonstrating improved specificity through structured test sequencing—this makes insurance denial less justifiable and strengthens appeal cases if necessary.

By eliminating unjustified test variation, insurers see lower risk of over-utilization, improving coverage acceptance.

Why This Matters

For Providers: BATWatch removes uncertainty around biomarker testing, ensuring that false positives/negatives don’t disrupt treatment decisions.

For Insurance Approvals: A structured, risk-adjusted testing model satisfies coverage criteria by demonstrating medical necessity in a way that aligns with standard insurer review protocols.

For Patients: By eliminating the guesswork and statistical noise, we ensure accurate, reliable biomarker assessment that enables early intervention before Alzheimer’s progression begins.

6. BAT Level Index, Risk Scoring, and Decision Engine

Purpose of the BAT Level Index: A Decision Engine for Testing & Treatment

The BAT Level Index (BLI) is a structured, multi-stage system designed to identify patients at risk for Alzheimer’s and determine the most appropriate course of action. The goal is to ensure that no patient is left untreated when intervention is possible while avoiding unnecessary or premature treatments for those who do not yet require them.

Given that beta-amyloid accumulation precedes tau-driven neurodegeneration, early intervention is crucial. Patients with a risk score of 20+ should receive the BAT Pill Protocol (BPP) before tau accumulation begins, as delaying intervention may lead to irreversible neuronal damage. However, T testing remains necessary before treatment begins to assess neurodegeneration severity.

6.1 BLI Score Stages & Decision Logic

The BATWatch protocol applies risk scoring across three critical phases:

Pre-Test Eligibility

Active Testing Risk

Final Intervention

Each stage refines patient stratification to ensure appropriate next steps are taken.

6.2 Pre-Test Risk Score

Purpose: The pre-test risk score is not a threshold for testing but rather a justification tool that helps assess the urgency of screening and provides insight into potential treatment adjustments. Since all patients 45+ qualify for BA testing, this scoring system prioritizes patients who may require additional screening or early intervention.

6.3 How It Guides Testing & Treatment:

Identifies potential mechanisms that contribute to BA accumulation.

Rules in or rules out modifiable risk factors (e.g., inflammation, metabolic dysfunction, APOE4 status) before testing even begins.

Helps determine urgency-higher scores indicate greater likelihood of early intervention needs.

Supports insurance pre-authorization by showing clear medical justification for testing sequences.

6.4 Active Testing Risk Score (Progressive Score)

Purpose: Updates risk based on BA Test results to determine if further testing (T Test) is required.

Justification:

Score = 0: Continue annual BA testing.

Score = 10: Monitor BA levels, retest in one year.

Score = 20-30: Strong justification for T Test. BPP treatment is recommended at this stage to prevent tau accumulation.

Score = 40-50: T Test is recommended immediately. BPP treatment is highly recommended to prevent progression.

Score = 50+: Early intervention is strongly justified before tau-driven neurodegeneration occurs.

Note: The full proprietary scoring formula is confidential and not disclosed to patients, ensuring the integrity of Silver House’s intellectual property.

6.5 Final Risk Score (Intervention Score)

Purpose: Determines if a patient should proceed with treatment immediately or undergo further risk stratification.

Justification:

Low Final Risk (Score < 10): Annual BA testing & lifestyle monitoring.

Moderate Final Risk (Score 20-50): Preventative intervention (BPP) is strongly recommended before tau accumulation begins.

High Final Risk (Score 60-100): BPP starts immediately.

60 (BA Positive, Tau Negative): BPP treatment to prevent neuron damage.

100 (BA & T Positive): BPP treatment to manage neuron damage and prevent further decline.

6.6 T Test as a Critical Step Before Intervention

Since pTau levels indicate neurodegeneration, a T Test is required before starting the BAT Pill Protocol.

If pTau is present, the intervention strategy must adjust based on severity.

If pTau is absent but BA is high, this is the ideal window for preventative treatment.

This ensures patients are treated at the right time, before irreversible neuronal damage occurs.

6.7 Why This Scoring System Works for Patients

Early intervention prevents cognitive decline rather than reacting once damage has already begun.

Patients don’t get put back in the queue when at risk—they get treated before tau levels rise.

The structured approach ensures treatment decisions align with biomarker progression, optimizing patient outcomes.

6.8 Why Risk Scoring is Essential

Objective Framework for Medical Necessity:

Ensures testing aligns with widely accepted risk stratification principles in medicine.

Creates a documented, evidence-based approach to support pre-auth requests.

Helps prove the need for testing and intervention to insurers.

Prevents Overuse & Redundant Testing:

Protects patients from unneeded interventions while ensuring those at highest risk receive prompt treatment.

Risk scoring ensures that each test follows a justified sequence, preventing unnecessary expenses for patients and payers.

6.9 Testing at 45 and Fighting Outdated Guidelines.

As demonstrated by the overwhelming evidence from decades of research, anyone 45+ should be regularly tested. It’s not even a question anymore.

6.10 Justification for Early Screening vs. Outdated USPSTF Guidelines

What Outdated Guidelines Get Wrong

USPSTF only recommends cognitive screening if symptoms are present.

By that point, damage is already occurring, making treatment far less effective.

This approach ignores decades of research showing beta-amyloid and tau accumulate silently for as much as 20 years before symptoms.

Alzheimer’s doesn’t begin at 65—it begins at 45 or earlier.

Why BAT Testing at 45+ Should Be the New Standard

Early screening detects the problem before it’s too late.

It follows the same model as cardiovascular screening—we don’t wait for heart attacks before testing cholesterol.

Cost-saving implications: Preventing cognitive decline is cheaper than treating dementia.

Aligns with modern Alzheimer’s research: The shift toward biomarker-based risk stratification supports early testing.

7. Overcoming Insurance Coverage Uncertainty

Many PCPs hesitate to recommend cognitive biomarker testing due to assumptions that insurance won’t cover it. However, BATWatch eliminates this concern by using a structured stratification protocol that aligns with insurer-approved medical necessity frameworks.

Solution:

• BATWatch simplifies insurance approvals through its risk-scoring protocol.
• Structured testing stratification ensures every test follows an insurer-justified sequence.
• PCPs don’t need to worry about insurance approvals—BATWatch handles pre-auth, appeals, and compliance.

Bottom line:

Insurance approval is prioritized based on medical necessity, which is determined through BATWatch’s structured testing sequence. By pre-filtering patients using validated risk factors and biomarker screening, the protocol ensures that only those with clear justification undergo further testing.

This approach not only reduces unnecessary costs but also strengthens pre-authorization approval rates by aligning with insurers’ evidence-based medical necessity criteria.

8. Barriers for Early and Effective Screening

8.1 The Challenges PCPs Face in Cognitive Screening

Primary Care Providers (PCPs) encounter significant hurdles in implementing comprehensive cognitive screening due to time constraints, competing priorities, and a lack of standardized screening protocols.

Studies show that the average primary care visit lasts only 18 minutes, during which providers must address multiple health concerns, often prioritizing acute and chronic conditions like cardiovascular disease, diabetes, and hypertension over cognitive health.

Additionally, many PCPs are not specifically trained to recognize preclinical cognitive impairment, resulting in underdiagnosis, misdiagnosis, and significant delays in treatment. This often means that opportunities for early intervention are missed, and patients are only diagnosed once irreversible damage has already begun.

Solutions:

PCP education campaigns via webinars, lunch-and-learns, and digital outreach to improve awareness.

Simplify referral process—”If a patient is 45+, order BAT Testing.”

Outsource screening to BATWatch—allowing PCPs to focus on core care while ensuring patients receive cognitive health assessments without increasing provider workload.

8.2 Addressing Patient Fears and Resistance to Testing

A major psychological barrier to early cognitive screening is the fear of an Alzheimer’s diagnosis. Studies indicate:

Over 50% of patients fear being diagnosed with dementia.

62% of individuals believe a dementia diagnosis means ‘life is over.’

This perception often leads to avoidance behavior, where patients refuse cognitive testing due to the belief that “there’s nothing that can be done.”

Solutions:

Reframe BAT Testing as a preventative measure, not a diagnostic test. The goal is to monitor and manage BAT Levels proactively, just like cholesterol.

Emphasize that cognitive decline is modifiable. Just as cardiovascular risk can be managed through statins, diet, and exercise, early BAT Testing allows for timely intervention to reduce risk.

Leverage the BAT Pill Protocol as a treatment solution. Patients feel more empowered when they know something can be done now to prevent damage, rather than waiting until symptoms appear.

8.4 How These Solutions Change the Landscape

The combination of simplified referrals, patient reassurance, and insurance strategy transforms BAT Testing from an optional screening into a routine part of preventive medicine.

By tackling PCP workload constraints, patient resistance, and insurance confusion, BATWatch ensures that cognitive health becomes as easy to monitor as cholesterol or blood pressure.

8.5 Ensuring Affordable Access to Life-Saving Screening

We are committed to breaking down financial barriers that prevent patients from accessing early cognitive health screening. We believe that life-saving preventive care should be available to everyone, regardless of their insurance coverage or financial situation.

8.5.1 The Reality of Insurance Limitations

We recognize that some patients may face challenges due to limited or inadequate insurance coverage. Cognitive biomarker testing is still emerging in preventive care, and many insurers do not cover these life-saving assessments without extensive documentation or appeals.

8.5.2 Our Commitment to Patient Access:

To ensure every patient has access to BAT Testing, regardless of their financial situation, we have implemented multiple patient-centered solutions:

a) Negotiated Lab Rates: We have partnered with multiple lab providers to secure significantly reduced rates for BAT Testing, ensuring our patients receive high-quality testing at the lowest possible cost.

b) Financial Assistance Programs: We offer financial aid options for qualifying patients, helping to reduce or cover the cost of testing for those facing economic hardship.

c) Simple, Interest-Free Payment Plans: For patients who prefer to pay over time, we provide flexible, interest-free payment options to make life-saving screening accessible without financial strain.

d) Transparent Pricing: We prioritize cost transparency, providing patients with clear, upfront pricing and no surprise bills.

Our Goal: To ensure that financial barriers never prevent a patient from receiving life-saving cognitive risk screening. We believe that early detection saves lives, and we are dedicated to making preventive care accessible to everyone.

9. Conclusion

These BAT Test Terms of Service outline the protocols, methodologies, and procedures for BAT Testing provided by Silver House through the BATWatch program. This document is limited to the BAT Testing process and scoring methodology and does not cover general service terms, which are provided separately in the BATWatch Terms of Service.

By participating in BAT Testing, you acknowledge your understanding of the testing process, scoring framework, and data use policies outlined above.