Legal

Last Updated: February 17, 2025

This Patient Financial Terms and Responsibility document (“Financial Terms”) outlines your financial obligations and payment responsibilities when participating in the BATWatch™ Program (“BATWatch”), operated by Silver House Healthcare, LLC (“Silver House”). These terms apply to all services provided under BATWatch, including BAT Testing, the BAT Pill Protocol (“BPP”), and Telehealth services.

1. General Financial Disclosures

a) No Charges for Initial Telehealth and In-Person Visits:

Silver House does not charge patients for the initial telehealth consultation or the in-person visit required to establish telehealth eligibility. These visits are provided at no cost to you, as Silver House believes these regulatory requirements should not impose financial burdens on patients.

b) Insurance Coverage and Patient Responsibility:

Silver House bills your health insurance for covered services where applicable. However, your insurance policy may require you to pay certain amounts, including co-pays, deductibles, or co-insurance.

You are responsible for any out-of-pocket costs not covered by your insurance.

c) Program Participation vs. Medical Services:

Participation in BATWatch itself is not billed separately. You are only billed for specific services provided within the program, such as testing, treatment, or telehealth services, if applicable.

2. Insurance and Billing Practices

2.1 Insurance Claims and Network Status:

Silver House accepts most major insurance plans. If Silver House is in-network with your insurance provider, we will bill your insurance directly.

If Silver House is out-of-network, you may be responsible for a larger portion of the service fees. You are encouraged to contact your insurance provider to confirm coverage.

2.2 Insurance Denials and Patient Liability:

If your insurance denies a claim, you will be notified and may be responsible for the full cost of the service unless the denial is successfully appealed.

Appeal Support: Silver House will actively assist you in appealing insurance denials by:

Providing necessary medical records and documentation.

Submitting letters of medical necessity to your insurer.

Working directly with your insurance company to advocate for coverage based on clinical evidence.

You may also request an itemized statement from Silver House to submit a claim for reimbursement to your insurance provider.

While Silver House will make every effort to overturn denials, coverage decisions are ultimately made by your insurance provider.

2.3 Pre-Authorizations and Coverage Limits:

Silver House will make reasonable efforts to obtain pre-authorization for services when required by your insurance. However, obtaining pre-authorization does not guarantee coverage or payment.

Some services, such as annual follow-up testing or extended BPP cycles, may be subject to coverage limits defined by your insurance policy.

3. Patient Out-of-Pocket Costs

3.1 Cost Transparency and Estimates:

Upon request, Silver House will provide a Good Faith Estimate (GFE) of anticipated charges for services not covered by insurance, in compliance with the No Surprises Act.

Cost estimates are provided for informational purposes only and may change if the scope of services changes.

3.2 Co-Payments, Deductibles, and Co-Insurance:

Co-Payments: Due at the time of service, if applicable.

Deductibles and Co-Insurance: You are responsible for any amounts required under your insurance plan.

3.3 Self-Pay Rates (For Uninsured or Out-of-Network Patients):

Silver House offers discounted self-pay rates for patients without insurance or who choose to self-pay. Contact our billing office for current rates.

4. Billing and Payment Terms

4.1 Billing Statements:

You will receive a billing statement for any patient-responsible charges after your insurance processes the claim. Statements will be delivered via your patient portal or by mail.

4.2 Payment Due Dates:

All payments are due within 30 days of the statement date unless a payment plan has been established.

4.3 Payment Methods Accepted:

Silver House accepts the following payment methods:

Credit/Debit Cards (Visa, MasterCard, American Express, Discover)

Health Savings Account (HSA) or Flexible Spending Account (FSA) payments

Bank Transfers

Payment via the Patient Portal

5. Payment Plans and Financial Assistance

5.1 Payment Plans:

If you are unable to pay your balance in full, Silver House offers interest-free payment plans. Contact our billing department to set up a plan that meets your needs.

5.2 Financial Assistance:

Silver House offers a Financial Assistance Program for qualifying patients facing financial hardship. Eligibility for assistance is based on household income and financial need.

To apply for assistance, you must submit a Financial Assistance Application with supporting documentation.

6. No Surprises Act and Good Faith Estimate (GFE)

6.1 Your Right to a GFE:

Under the No Surprises Act, you are entitled to a Good Faith Estimate (GFE) if you are:
Uninsured, or
Choosing to self-pay for services.

The GFE outlines the expected cost of services and is provided before your scheduled appointment or upon request.

6.2 Balance Billing Protections (Out-of-Network Services):

Silver House complies with federal and state laws prohibiting balance billing for emergency services and certain non-emergency services provided by out-of-network providers.

7. Refund and Cancellation Policy

7.1 Service Refunds:

Refunds are only issued if a billing error occurs or if a pre-paid service is canceled by Silver House before completion.

Refunds are not provided for services that have already been rendered.

7.2 Appointment Cancellations and No-Show Fees:

Telehealth Appointments: No fees are charged for cancellations or missed telehealth consultations.

In-Person Visits: Silver House may charge a fee for no-show appointments or cancellations made less than 24 hours before the scheduled visit. Fees will be outlined in your appointment confirmation.

8. Financial Responsibility Acknowledgment

By participating in the BATWatch™ Program, you acknowledge and agree that:

You are responsible for all charges not covered by insurance, including deductibles, co-pays, co-insurance, and any non-covered services.

You have reviewed and accepted the terms outlined in this document.

You consent to Silver House billing your insurance and receiving direct payment from your insurer.

You understand that unpaid balances may be referred to a collection agency if not resolved within the agreed-upon timeframe.

9. Disputes and Billing Inquiries

Billing Inquiries: If you believe there is an error on your bill, contact Silver House’s billing department within 30 days of receiving your statement.

Dispute Resolution: Any disputes related to billing are subject to the procedures outlined in the Dispute Resolution and Arbitration Terms.

10. Changes to Financial Terms

Silver House reserves the right to update or modify these Financial Terms at any time. Material changes will be communicated via the patient portal or email. Continued participation after notice of changes constitutes acceptance of the updated terms.

11. Contact Information for Billing and Financial Assistance

For questions regarding billing, payments, or financial assistance, contact:

Silver House
Attn: Billing
15411 W. Waddell Rd
Ste 102
Surprise, AZ 85379

12. Affirmative Consent to Financial Terms

By signing the BATWatch Program Enrollment Form or acknowledging these terms electronically through the patient portal, you affirm that you:

Have read and understood these Patient Financial Terms and Responsibility.

Agree to be financially responsible for all charges incurred.

Consent to be billed according to these terms.