Medical Terms of Service
Last Updated: May 6, 2021
These Medical Terms of Service govern your use of the medical services, including the telehealth services described in more detail herein, (“Medical Services”) provided by affiliates of Her M.D., Inc. (“HerMD”), including Somi Javaid MD & Associates, LLC and SJ Medical Spa, LLC, (“HerMD Affiliates”, “we”, “us”, or “our”). Please read the Medical Terms of Service carefully before using the Medical Services. By using the Medical Services, you agree to be bound by these Terms. If you are accepting these Medical Terms of Service for another person (“Dependent”) as such person’s parent, guardian, conservator, or custodian, you agree to the terms, conditions, and notices contained or referenced herein on behalf of such Dependent.
The HerMD Affiliates are affiliated with HerMD, where HerMD provides management and administrative services to the HerMD Affiliates. HerMD also provides other non-medical services to consumers, and the User Terms of Service govern your use of the services provided by HerMD. Please read the User Terms of Services carefully before using HerMD’s services.
Please refer to our HIPAA Privacy Practices to learn how we collect, use, share and protect your Protected Health Information (as defined under the Health Insurance Portability and Accountability Act of 1996 or “HIPAA”).
Please do NOT use the Medical Services for emergency or urgent medical matters. For all urgent or emergency matters that you believe may immediately affect your health, you must immediately call 9-1-1 or go to the nearest emergency room or urgent care facility.
1. Updates to the Medical Terms of Service
We may modify these Medical Terms of Service from time to time. We will notify you of material changes by posting the amended terms on the HerMD website at least thirty (30) days before the effective date of the changes. If we have your email on file, we will also notify you of material changes to the Medical Terms of Service by email at least thirty (30) days before the effective date of the changes. Please make sure we have your current email address so that you will receive notice of any material changes. If you do not agree with the proposed changes, you should discontinue your use of the Medical Services before the effective date of the change. If you continue using the Medical Services after the effective date, you will be bound by the updated Medical Terms of Service.
2. Your Financial Responsibility; Assignment of Benefits
You agree to pay the HerMD Affiliates all applicable charges at the prices then in effect for the Medical Services provided to you or another person on whose behalf you are accepting these Medical Terms of Service and/or payment responsibility (such as your children or other family members) (“Covered Family Member”). You will be charged for the Medical Services, including complementary and alternative services provided to you or your Covered Family Member by a HerMD Affiliates healthcare service provider (each, a “Provider”). You authorize HerMD Affiliates to charge your chosen payment method (your “Payment Method”) for the Medical Services provided to you or your Covered Family Member. If your Payment Method is invalid at the time payment is due, you agree to pay all amounts due upon demand. The third party services provider who manages your Payment Method may impose terms and conditions on you, which are independent of these Medical Terms of Service, and you agree to comply with all of those terms. HerMD Affiliates may accumulate charges that you’ve incurred for the Medical Services and submit them as one or more aggregate charges during or at the end of each billing cycle. HerMD Affiliates reserve the right to correct any billing errors or mistakes even if payment has already been requested or received.
If you provide information about your health insurance or health plan, that will be deemed your authorization for us to submit claims for covered Medical Services to your health insurer or health plan. You hereby assign or otherwise authorize payment of medical benefits to us for the Medical Services provided to you or your Covered Family Member. You authorize the release of any medical or other information necessary to process any claims for the Medical Services provided. You understand that you are responsible for all co-payments, amounts applied to deductibles, and any other amounts that may be deemed your responsibility by your health insurer or health plan for the Medical Services provided to you or your Covered Family Member. You further understand and accept your financial responsibility for any portion of the bill not covered by your health insurer or health plan. SUBMISSION OF CHARGES DOES NOT WAIVE OUR RIGHT TO SEEK PAYMENT DIRECTLY FROM YOU.
You understand that your contract with your health insurer or health plan may not cover some Medical Services provided by HerMD Affiliates. All insurance policies and plans are not the same and vary by employer group. HerMD Affiliates are not responsible or able to know every policy available. It is your responsibility to verify applicable coverage prior to receiving the Medical Services. For example, not all health plans include screenings as a benefit. If you
seek Medical Services outside of your contract terms, you are aware that you may be responsible for all charges that are incurred. ALL SALES ARE FINAL. No monetary refund will be given on sales of products or services.
Accounts that are 120 days past due from the date of treatment will be turned over to collections. An additional processing fee of $250.00 will be charged to your account if it is turned over to collections. There will be a charge of $30.00 for any returned non-sufficient funds check.
3. No Shows and Late Cancellations
When an appointment is made, it takes an available time slot away from other patients. No Shows and Late Cancellations delay the delivery of health care to other patients, some of whom are quite ill. A “No Show” is missing a scheduled appointment. A “Late Cancellation” is cancelling an appointment within 24 hours of your scheduled gynecology or medical aesthetic appointment, or 48 hours in advance of a surgical procedure.
A charge of $50.00 may be assessed for each No Show or Late Cancellation of a scheduled regular gynecology appointment. A charge of $200.00 may be assessed for each No Show or Late Cancellation of a scheduled surgical procedure. A charge of $75.00 may be assessed for each No Show or Late Cancellation of a scheduled medical aesthetic appointment. You understand that insurance companies consider this charge to be entirely the patient’s responsibility.
4. Permission to Treat
You authorize HerMD Affiliates and their employees working under the direction of a Provider, to provide medical care for you or your Covered Family Member. This medical care may include (but is not limited to) preventative, diagnostic, therapeutic, rehabilitative, maintenance, palliative care, counseling, assessment or review of physical or mental status/function of the body and the sale or dispensing of drugs, devices, equipment or other items required and in accordance with a prescription. This consent includes contact and discussion with other health care professionals for care and treatment. You may withdraw this consent at any time by no longer seeking Medical Services from HerMD Affiliates.
You have had a chance to review the HIPAA Privacy Practices, which describe how your Protected Health Information (as defined by HIPAA) (“PHI”) may be used and disclosed and how you can get access to this information. You understand you have the right to request how your PHI has been disclosed. You also have the right to request restrictions on how this information is disclosed, but HerMD Affiliates are not required to agree to your restrictions. If HerMD Affiliates do agree to your restrictions on PHI use, they are bound by this agreement. You understand and agree that, as part of providing Medical Services to you, your PHI, including test results, may be released to an online personal health record and via communication with HerMD Affiliates’ healthcare team electronically (in accordance with our HIPAA Privacy Practices).
5. Service Termination
You may terminate your use of the Medical Services at any time by not using the Medical Services any more. We may terminate your use of the Medical Services at any time in our reasonable discretion, for causes including but not limited illegal conduct such as falsifying information to obtain controlled substances, abusive and threatening behavior, and continued refusal to pay for our services. We may terminate your use of the Medical Services by sending notice to you at the mail or email address you provided to us or by otherwise contacting you.
6. Consent to Electronic Communications
You agree that HerMD and HerMD Affiliates may send the following to you by email or by posting them on our website and mobile application: legal disclosures; these Medical Terms of Service, HIPAA Privacy Practices; future changes to any of the above; and other notices, policies, communications or disclosures and information related to the Medical Services. You agree that HerMD and HerMD Affiliates may contact you via secure messaging, email, phone, text, fax, or mail regarding the Medical Services, which may include PHI. You consent to receive such communications electronically. You agree to update your contact information to ensure accuracy.
If you later decide that you do not want to receive certain future communications electronically, please send an email to email@example.com or a letter to HerMD at 8350 E Kemper Road, Suite A, Cincinnati, OH 45249. You may also opt out of certain electronic communications through your account or by following the unsubscribe instructions in any communication you receive from HerMD or HerMD Affiliates. Your withdrawal of consent will be effective within a reasonable time after we receive your withdrawal notice described above.
HerMD and HerMD Affiliates will need to send you certain communications electronically regarding the Medical Services. You will not be able to opt out of those communications – e.g., communications regarding updates to these Medical Terms of Service or information about billing. Your withdrawal of consent will not affect the legal validity or enforceability of the Medical Terms of Service provided to and accepted by, you.
7. Mental Health Services Disclaimer
Medical Services may involve discussing sensitive aspects of your life in person or via TeleHealth (defined below). You may experience uncomfortable feelings like sadness, guilt, anger, frustration, loneliness, or helplessness. If at any point you experience significant increased distress or have thoughts of harming yourself or others, you agree to notify your mental health provider so that an appropriate level of support can be provided. Your mental health provider may utilize a set of psychological symptom questionnaires in order to assist with determining a diagnosis and track your progress in counseling, and may discuss the nature of these assessments and your results when applicable.
TO THE MAXIMUM EXTENT NOT PROHIBITED BY LAW, EXCEPT IN CASE OF NEGLIGENCE OR WILLFUL MISCONDUCT, WE AND OUR AFFILIATES, PROVIDERS, EMPLOYEES, OFFICERS, DIRECTORS OR AGENTS WILL NOT BE RESPONSIBLE FOR ANY LOSS OR DAMAGE, INCLUDING PERSONAL INJURY OR DEATH, RESULTING FROM ANYONE’S USE OF OR INABILITY TO USE THE MEDICAL SERVICES.
The Medical Services are intended for use only within the United States and its territories. We make no representation that the Medical Services are appropriate, or are available for use outside the U.S. Those who choose to access and use our Medical Services from outside the U.S. do so on their own initiative, at their own risk, and are responsible for compliance with applicable laws.
9. Limitation of Liability
TO THE MAXIMUM EXTENT NOT PROHIBITED BY LAW, IN NO EVENT WILL WE AND OUR AFFILIATES, PROVIDERS, EMPLOYEES, OFFICERS, DIRECTORS OR AGENTS BE LIABLE FOR ANY CONSEQUENTIAL, EXEMPLARY, INCIDENTAL, SPECIAL OR PUNITIVE DAMAGES, INCLUDING WITHOUT LIMITATION THOSE RELATING TO LOST PROFITS OR THE COST OF SUBSTITUTE PRODUCTS OR SERVICES ARISING OUT OF OR IN CONNECTION WITH THE MEDICAL SERVICES OR FROM THE USE OF OR INABILITY TO USE THE MEDICAL SERVICES, WHETHER BASED ON CONTRACT, WARRANTY, PRODUCT LIABILITY, TORT OR OTHER LEGAL THEORY AND EVEN IF WE HAVE BEEN INFORMED OF THE POSSIBILITY OF SUCH DAMAGES. SOME JURISDICTIONS DO NOT ALLOW THE EXCLUSION OR LIMITATION OF LIABILITY FOR CONSEQUENTIAL OR INCIDENTAL DAMAGES, SO THE ABOVE EXCLUSION MAY NOT APPLY TO YOU.
12. Telehealth Services and Permission
You give permission to HerMD Affiliates to provide certain TeleHealth (defined below) services to you or your Covered Family Member (the “TeleHealth Services”). You consent to receive emails or other electronic communications from HerMD and HerMD Affiliates pertaining to your care and your health (or that of your Covered Family Member), which may include PHI. You understand that virtual encounters via phone, email, video, or otherwise, could involve, and you hereby consent to the use of, automated tools for diagnosis, care, treatment or communication pertaining to healthcare matters. You also acknowledge that such virtual encounters may involve care by a variety of Providers, including Physicians, Registered Nurses, Nurse Practitioners, Physician Assistants, Nutritionists, Naturopathic Doctors, Therapists, and other support or medical personnel (“TeleHealth Services Providers”).
“TeleHealth” is the delivery of healthcare services using technology when the healthcare provider and patient are not in the same physical location, and/or the virtual delivery of healthcare services, including by a medical provider or via digital or automated tools, including without limitation tools for medical or health-related diagnosis and treatment. The TeleHealth Services may be used for diagnosis, treatment, care, follow-up and/or patient education, and may include, without limitation, the following: electronic transmission of patient medical records, medical images, and/or other patient data or information; synchronous (i.e., “real time”) and asynchronous (i.e., non-“real time”) interactions via audio, video, text, and/or data or other electronic communications; automated, electronic or digital tools or services for diagnosis, care, treatment and/or communication pertaining to healthcare or medical matters; and output, transmission or exchange of data from medical devices, sound and video files. Further, you understand that it may be possible that your condition cannot be treated via the TeleHealth Services, or that information transmitted through the TeleHealth Services may not be sufficient or of too poor of image quality, or insufficient information or data to allow for appropriate medical decision making. Accordingly, you may be required to seek additional in-person medical care, alternative healthcare or emergency services. If your health or medical problem or condition persists after use of TeleHealth Services, you will immediately contact your medical services provider and seek appropriate additional in-person medical care or emergency care, as appropriate.
You give permission to HerMD Affiliates and the TeleHealth Services Providers to record and process your personal details and medical data. Video, audio and / or photo recordings may be taken of you during the TeleHealth Services. However, not all TeleHeath communications are recorded and stored. You hereby release HerMD Affiliates and TeleHealth Services Providers from any and all liability which may arise from the taking and authorized use of such videotapes, digital recording films and photographs. You may withdraw these permissions at any time by no longer seeking Telehealth Services from HerMD Affiliates.
13. General Provisions
These Medical Terms of Service make up the entire agreement relating to your use of the Medical Services, and supersede all prior agreements relating to the subject matter hereof.
We may change, suspend, or discontinue any of the Medical Services at any time. We will try to give you prior notice of any material changes to the Medical Services. We will not be liable to you or to any third party for any modification, suspension or discontinuance of the Medical Services.
You may not transfer any of your rights or obligations under these Medical Terms of Service to anyone else without our consent. HerMD and HerMD Affiliates may assign their rights in connection with a merger, acquisition, or sale of assets, or by operation of law or otherwise.
Even after termination, these Medical Terms of Service will remain in effect such that all terms that by their nature may survive termination will survive such termination. If you have any questions about these Medical Terms of Service, please contact firstname.lastname@example.org.