Privacy Policy

Terms of Service

These Terms of Service apply to all services by Coze Health Medical LLC (“Coze Health,” “we,” “us”),

including in-clinic visits, group visits, telehealth, portal messaging, and any care management or

monitoring services.

By signing the intake form (in-person or electronically), you acknowledge that you have read and agree

to these Terms of Service.

IMPORTANT NOTICES (Please read)

1) BILLING NOTICE (Including Non-Face-to-Face Services)

Some services may be billable even when you do not have an in-person visit. These services may include,

but are not limited to:

Chronic Care Management, Advanced Primary Care Management, or Primary Care Management (CCM/APCM/PCM)
Remote Patient Monitoring (RPM)
Telehealth and virtual visits
Certain medical responses to portal messages or phone calls

Insurance coverage varies. Copays, coinsurance, deductibles, or other patient responsibility amounts may

apply, and you may be responsible for amounts not covered.

2) COMMUNICATION NOTICE

You may choose to receive communications from Coze Health by phone, voicemail, text message, email,

or patient portal. Some communication methods may not be fully secure. You may update your

communication preferences at any time.

3) GROUP VISIT PRIVACY NOTICE

If you participate in a group medical visit, other participants may hear personal health information. While

confidentiality is expected, Coze Health cannot control what other participants may share outside the

group.

SECTION 1 — NOTICE OF PRIVACY PRACTICES (HIPAA)

Coze Health Medical may use and disclose your protected health information (PHI) as permitted by law for:

Treatment, including coordination with other providers involved in your care
Payment
Health care operations

Electronic Health Information Exchange

We may make your PHI available electronically through a health information exchange to other health

care providers that request your information for treatment purposes. In all cases, the requesting provider

must have or have had a treating relationship with you. Participation in a health information exchange

also allows us to receive information from other providers for your treatment.

You have rights under HIPAA, including the right to access your medical records, request amendments,

and receive a copy of this Notice of Privacy Practices.

We may also disclose PHI as required by law (public health reporting, oversight activities, court orders,

law enforcement, workers’ compensation, etc.).

SECTION 2 — INFORMED CONSENT FOR CARE

You consent to examination, diagnosis, and treatment as determined appropriate by your provider. You

understand that you may ask questions at any time and may decline treatment.

You authorize Coze Health Medical to use and disclose your PHI for treatment, payment, and health care

operations, including disclosure to your insurance plan.

You understand that insurance coverage is not guaranteed and that you are responsible for charges not

covered by insurance.

SECTION 3 — CARE MANAGEMENT (CCM / APCM / PCM)

If you qualify, Coze Health Medical may offer care management services, which may include care coordination,

medication oversight, preventive care support, and enhanced access through the patient portal.

Only one provider may bill care management services for you during a calendar month. Cost-sharing may

apply even when services do not involve a face-to-face visit.

Participation in care management is voluntary. You may discontinue care management at any time,

effective at the end of the current month, by notifying Coze Health Medical.

Patients who do not participate in care management may continue receiving care through traditional

appointment-based services with standard scheduling availability.

SECTION 4 — TELEHEALTH AND VIRTUAL CARE

Telehealth services may include real-time video or audio visits and other virtual services. Technical issues

may occur. Insurance coverage varies, and you may be responsible for charges not covered by insurance.

You must be located in a state where your provider is licensed at the time of the telehealth visit.

SECTION 5 — REMOTE PATIENT MONITORING (RPM)

Remote Patient Monitoring may be prescribed when medically appropriate and may involve third-party

vendors for device support, data transmission, and platform services. Cost-sharing may apply based on

your insurance plan.

SECTION 6 — NUTRACEUTICALS AND THIRD-PARTY SERVICES

Your provider may recommend supplements or nutraceuticals as part of your care. You are not required to purchase these

products from Coze Health Medical , and they may not be covered by insurance. Coze Health Medical may receive compensation from third-party vendors.

Coze Health Medical also uses third-party vendors to support services such as electronic health records, telehealth platforms, and secure patient communications. Appropriate agreements are in place where required by law.

SECTION 7 — FINANCIAL POLICY

Payment Method on File

All patients must maintain a valid payment method on file.

Insurance Billing and Timing

Coze Health Medical bills insurance first. After insurance processes a claim and issues an Explanation of Benefits

(EOB), any remaining patient responsibility may be charged to the payment method on file.

By signing, you authorize Coze Health Medical to charge your payment method on file for amounts you owe. You

will receive notice before a charge is processed and may update your payment method or contact us with

questions.

Credit Card Processing Fees

A credit card processing fee may apply to payments made by credit card in the future. Any such fee will

be disclosed in advance and will not apply to debit cards. Lower-cost payment options, such as electronic

check, may be available.

Cancellation and No-Show Fees

Appointments not canceled at least 48 hours in advance may be charged a cancellation fee. Missed

appointments may be charged a no-show fee.

Outstanding Balances

Outstanding balances may affect scheduling of non-urgent services. Payment plans are available.

Medically necessary care will not be withheld.

SECTION 8 — CHANGES AND QUESTIONS

Coze Health may update these Terms of Service from time to time. The most current version will be

available on our website.

Questions may be directed to:

Coze Health Medical LLC

156 Sagamore Pkwy W, Suite A

West Lafayette, IN 47906

ACKNOWLEDGEMENT [Form is sent electronically].

By signing, you acknowledge that you have read and agree to these Terms of Service and understand that

certain services may be billable, including non-face-to-face care.

Certain services may require additional, service-specific consents, which will be provided if applicable.

You consent to examination, diagnosis, and treatment as determined appropriate by your provider. You

understand that you may ask questions at any time and may decline treatment.

You authorize Coze Health to use and disclose your PHI for treatment, payment, and health care

operations, including disclosure to your insurance plan.

You understand that insurance coverage is not guaranteed and that you are responsible for charges not

covered by insurance.