Elle Medicine Terms and Conditions

1. Initial Term.  Hybrid Practice Model.  During the initial term, Advanced Women’s Healthcare will bill member’s insurance for medical treatment provided by Advanced Women’s Healthcare’s physicians and providers.

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2. Insurance or Other Medical Coverage. Patient acknowledges and understands that this Agreement is not an insurance plan, and not a substitute for health insurance or other health plan coverage (such as membership in a PPO). This Agreement will not cover hospital services, or any services not personally provided by Practice, or Physician. Patient acknowledges that Practice has advised  Patient to obtain or keep in full force such health insurance policies or plans that will cover Patient for general healthcare costs. Patient acknowledges that this Agreement is not a contract that provides health insurance, and this Agreement is not intended to replace any existing or future health insurance or health plan coverage that Patient may carry. In addition, Practice makes no guarantee as to whether any services provided by Practice or Physicians are covered by, or reimbursable by any Health Savings Account (“HSA”). Patient understands that the determination of coverage by a HSA is solely determined in accordance with the particular HSA’s applicable policies and procedures. Patient is responsible for determining whether particular Services are covered by Patient’s HSA and, if covered, for submitting such claims. Practice will provide reasonable assistance in facilitating appropriate billing for purposes of HSA coverage and reimbursement.

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3. Concierge Practice Out-of-Network. Practice and Physician are out-of-network providers and may at any time bill as out-of-network providers. This means that neither the Physician nor the Practice participate “in-network” with Medicare or any commercial insurance plan and services provided by Practice and Physician are not covered by your health care insurance plan.  As such, not all services provided by Practice and Physician may be covered by Patient’s health care insurance plan.  Although Physician may assist Patient with identifying documentation for reimbursement from Patient’s health savings account, if any, by signing this Agreement, Patient is acknowledging and agreeing to be individually responsible to pay for all services provided to Patient by Physician or Practice. Membership Fees are not applied towards patient’s plan deductibles.  

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4. Outside Referrals. Patient may be referred to other providers for specialty services, ancillary, imaging, laboratory or inpatient services that are not provided by Practice or Physician and not included within the scope of this Agreement.  This is at Patient’s expense and not included in the membership fee.

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5. Medicare Notice. If Patient is a patient who is entitled to benefits under or is enrolled in Part B of Medicare, then Patient (a) acknowledges that Practice has not been excluded from participation under the Medicare Program, and (b) understands that Practice has voluntarily elected to opt out of and not participate in the Medicare Program. Patient expressly agrees not to submit a claim (or request that Practice submit a claim) under the Medicare Program or to any intermediary or carrier of the Medicare Program for any portion of the Membership Fee or for any physician services bill rendered to Patient by Practice even if such services are otherwise covered by Medicare. Patient acknowledges that Patient will be responsible for payment for such services and that no reimbursement will be provided under the Medicare Program or any Medigap plan for the Membership Fee or any such physician bill and that other supplemental insurance plans may elect not to reimburse Patient for such items. Patient further acknowledges that the limits the Medicare Program places on what a health care provider participating in the Medicare Program may charge for services rendered DO NOT APPLY to the Membership Fee or to any Services rendered to Patient by Practice. Further, Patient acknowledges that (i) Patient has the right to obtain Medicare-covered services from physicians who actively participate in the Medicare Program, (ii) Patient is not currently facing an emergency or urgent health care situation, and (iii) Patient has voluntarily elected to enter into this Agreement for the provision by Practice of services that might be eligible for payment or reimbursement by Medicare if they were rendered by a physician who continued to participate in the Medicare Program subject to the submission of an appropriate Medicare claim.

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6. Emergencies. In the event of an emergency, Patient must call 911 or go to the nearest emergency room.  A qualified physician will be available 24/7, however, Patient is not guaranteed to see Dr. Heintges on an emergency basis.  

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7. Forms.  Patient agrees to complete forms and documents provided by Practice related to Patient’s membership upon reasonable request.

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8. Termination. Elle Medicine strives to provide 100% satisfaction.  If you are not satisfied for any reason, Patient and Practice each shall have the absolute and unconditional right to terminate the Agreement prior to expiration of the Term, without the showing of any cause for termination, upon giving at least thirty (30) days prior written notice to the other party.  Any prorated Membership Fee will be refunded upon termination.  

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Upon termination, Practice will provide Patient with a letter formally discharging Patient from the care of Practice and Physician and if known, will state to whom Patient’s care and medical records are being transferred. Practice will provide for the timely transfer of all Patient medical records maintained and possessed by Practice at the time of termination, to Patient’s new primary care physician, upon written request and completed HIPAA authorization to transfer the documentation.  At such time of termination, Patient acknowledges that Patient will be responsible for ensuring that that Patient has secured a new physician relationship, including coverage for any emergencies, prescriptions, or any other medical needs.  As a courtesy, Physician may be available for emergencies, prescriptions, or other medical needs for thirty (30) days after the termination of the Agreement, if Patient has not secured a new health care provider or established a new physician relationship, but any such services will be rendered on a per instance fee basis and any such fee shall be due at the time of service.  

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If the Term of this Agreement expires or the Agreement is terminated, Patient will have no further obligation to pay any Membership Fees hereunder that are due beyond the date of expiration or termination date, This does not eliminate or void the obligation of Patient to pay any such fees that are past due, but yet unpaid at the time of termination

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9. Reimbursement for Services Rendered. If this Agreement is held to be invalid for any reason, and if Practice is therefore required to refund all or any portion of the Membership Fee paid by Patient, Patient agrees to pay Practice an amount equal to the reasonable value of the Services actually rendered to Patient during the period of time for which the refunded fees were paid.

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10. Amendment. Practice may unilaterally amend these Terms and Conditions at any time in is sole discretion without notice to Patient.  Any such changes are incorporated by reference into the Agreement without the need for signature by the parties and are effective as of the date established by Practice. Moreover, if applicable law requires the Agreement or Terms and these Conditions to contain provisions that are not expressly set forth in this Agreement these Terms and Conditions, then, to the extent necessary, such provisions shall be incorporated by reference into this Agreement and shall be deemed a part of this Agreement as though they had been expressly set forth in this Agreement.

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11. Legal Significance; Relationship of the Parties. Patient acknowledges that the Agreement and these Terms and Conditions are a legal document and creates certain rights and responsibilities. Patient also acknowledges having had a reasonable time to seek legal advice regarding the Agreement and has either chosen not to do so or has done so and is satisfied with the terms and conditions of the Agreement. The membership established a fee for service relationship pursuant to which Practice is acting as an independent contractor providing the Services in accordance with this Agreement.  Patient’s status with Practice does not mean that Patient is an investor or has an ownership or financial interest in Practice.

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12. Governing Law. This Agreement shall be governed and construed under the laws of the State of Texas, without regard to its principles of conflicts of laws.

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13. Arbitration. The parties shall use their respective best efforts to settle amicably any disputes, differences or controversies arising between the parties out of or in connection with or in respect of this Agreement.  However, if not so settled, then the same shall be submitted to arbitration and, to the fullest extent permitted by law, be solely and finally settled by confidential binding arbitration, except as specifically provided otherwise herein.  The confidential proceedings shall be held in Dallas, Texas and shall be conducted in accordance with the alternative dispute resolution rules of the American Arbitration Association. The foregoing provisions of this Section do not limit the right of a party to seek injunctive or other equitable relief from a court of competent jurisdiction pending resolution of a dispute by arbitration.

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14. Jurisdiction and Venue. Subject to the arbitration provision set forth above, any judicial proceeding brought by or against either of the parties on any dispute arising out of this Agreement or any matter relating thereto shall be brought in any federal or state court sitting or having jurisdiction in Dallas County, Texas, and by execution and delivery of this Agreement, each party hereby accepts for itself the exclusive jurisdiction and venue of the aforesaid courts as trial courts, and irrevocably agrees to be bound by any final non-appealable judgment rendered in connection with this Agreement.

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15. Notices. All written notices are deemed delivered if sent to the address of Practice as set forth above or to the address of Patient as entered in Practice’s electronic health record by first class U.S. mail or reputable overnight courier service (providing proof of delivery).

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16. Force Majeure. Neither party will be liable to the other for any cause beyond its reasonable control, and the party’s obligations of its obligations under these Terms and Conditions of the Membership Agreement, other than Patient’s payment obligations, will be excused if such party’s performance is prevented by any cause or causes beyond its reasonable control without the fault or negligence of such party.  Practice shall have no liability or responsibility for interruptions in the availability of or access to the Services outside of Practice’s control and such interruptions shall not be grounds for refund and/or credit.

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17. Waiver of Breach. The waiver by either party of a breach or violation of these Terms or Conditions or of a provision of the Membership Agreement shall not operate as, or be construed to be, a waiver of any subsequent breach of the same or other provision hereof.

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18. Severability. If any provision contained in the Agreement is determined to be void, illegal or unenforceable, in whole or in part, then the other provisions contained herein shall remain in full force and effect as if the provision which was determined to be void, illegal or unenforceable had not been contained herein.

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19. Counterparts. The Agreement may be executed in multiple counterparts, each of which shall constitute an original and all of which shall constitute one document; and furthermore, a facsimile or electronic signature hereon shall be deemed to be an original.

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