Membership Agreement & Terms and Conditions

Welcome to your Heart of Wellness Optimal Health Membership! The following terms and conditions govern the Heart of Wellness Optimal Health Service Agreement between Heart of Wellness, PS (herein as Heart of Wellness, “Heart of Wellness Optimal Health,” “Heart of Wellness Optimal Health Membership,” “Optimal Health,” “us,” “we” or “our”) and each person listed on the electronic registration form (herein as “you,” “your,” “member,” or “members.”)

IMPORTANT: THIS AGREEMENT DOES NOT PROVIDE COMPREHENSIVE HEALTH INSURANCE COVERAGE. IT PROVIDES ONLY THE HEALTH CARE SERVICES SPECIFICALLY DESCRIBED AND IT PROVIDES ONLY A LIMITED NUMBER OF THESE SERVICES. WHILE IT OFFERS MANY OF THE BENEFITS OF PRIMARY CARE IT IS NOT A PRIMARY CARE PLAN NOR A SUBSTITUTE FOR PRIMARY CARE. HEART OF WELLNESS OPTIMAL HEALTH MEMBERSHIP IS ALSO NOT AN INSURANCE PLAN NOR AN INSURANCE COMPANY.

We encourage members to obtain and maintain insurance for primary care and other services not provided under their Heart of Wellness Optimal Health Membership. The Heart of Wellness Optimal Health Membership fee covers certain services provided at our office as outlined in this agreement. We do not bill insurance carriers for services provided for Heart of Wellness Optimal Health members under this agreement. By enrolling in this Heart of Wellness Optimal Health Service Agreement and receiving services from us, you and all other members identified in the electronic registration form agree to these terms and conditions and acknowledge that you are voluntarily becoming an Heart of Wellness Optimal Health member. By signing this agreement, you acknowledge that you had an opportunity to ask questions and receive answers regarding this agreement. Please read these terms and conditions carefully.

SECTION 1 – INTRODUCTION

Heart of Wellness Optimal Health is an innovative and affordable membership-based program that provides a broad range of personalized medical services directly to patients, creating a meaningful patient experience by providing truly holistic care and coaching to help patients achieve their optimal health and wellbeing.

SECTION 2 – COVERED SERVICES

The Heart of Wellness Optimal Health membership fee covers only the specific services performed in our office by Heart of Wellness clinicians (“Clinicians” or “Clinician”) and/or support staff (“Staff”) as outlined in this agreement and at a frequency deemed medically necessary by us. These services are described in this section and in Section 3 – Other Covered Services (below). All other services are excluded.

Naturopathic Physician Visits. Heart of Wellness Optimal Health membership includes preventative or problem-focused appointments during normal business hours up to the following limits:

  • Bronze: 4 visits per year
  • Silver: 6 visits per year
  • Gold: 8 visits per year
  • Platinum: 10 visits per year

Health Coach / Nutritionist Visits. Heart of Wellness Optimal Health membership includes lifestyle or problem-focused appointments during normal business hours up to the following limits:

  • Bronze: 4 visits per year
  • Silver: 6 visits per year
  • Gold: 8 visits per year
  • Platinum: 10 visits per year

Acupuncture / Massage Therapy Visits. Heart of Wellness Optimal Health membership includes lifestyle or problem-focused appointments during normal business hours up to the following limits:

  • Bronze: 4 visits per year
  • Silver: 6 visits per year
  • Gold: 8 visits per year
  • Platinum: 10 visits per year

Classes / Group Sessions. Heart of Wellness Optimal Health membership includes classes and group visits up to the following limits:

  • Bronze: 4 classes / group visits per year
  • Silver: 6 classes / group visits per year
  • Gold: 8 classes / group visits per year
  • Platinum: 10 classes / group visits per year

You have 12 months commencing from the date we confirm your membership (“Effective Date”) to use your visits and classes. After that time your membership may be renewed according to the terms of this agreement. Visits do not roll over.

If you exceed your allotted number of visits or classes per year in any category you are entitled to further visits and classes at discounted rates available especially for Heart of Wellness Optimal Health members. The following charges will apply, with payment due at the time of service:

  • Physician visits: $120 per 40 minute visit
  • Health Coach / Nutritionist visits: $80 per 55 minute visit
  • Acupuncture or Massage visits: $65 per 55 minute visit
  • Classes / Group Visits: $20 per class or visit

SECTION 3 – OTHER COVERED SERVICES

Access to Clinicians. Members shall have access to their Clinicians during office visits and virtual visits (during normal business hours) and by patient portal. Reasonable efforts will be made to ensure that patient communications are responded to within 48 business hours.

Wait Times. Reasonable efforts will be made to ensure that appointments are scheduled so that there is no or very little wait time when you arrive for your appointment. Reasonable effects will be made to accommodate patients with urgent needs and this may sometimes result in unexpected wait times.

Patient Portal. You will have direct patient portal access to your Clinicians and other Staff of Heart of Wellness. We will make reasonable efforts to answer all email correspondence within 48 business hours. The patient portal should be used for non-urgent questions and concerns. For urgent concerns please call our office and ask to speak with the Medical Assistant. In the event of an emergency, you should call 911 immediately and/or proceed directly to the emergency room.

Scheduling Appointments. Appointments for office and virtual visits can be scheduled by phone, patient portal, or at the office. As a courtesy to other patients we ask that you notify us of your cancellation 24 hours prior to your scheduled appointment time. Missed appointments or cancellations made after 24 hours prior to the scheduled appointment time shall result in the cancelled visit counting against your annual limits. Reasonable exceptions will be made for emergencies.

Prescriptions. Most prescriptions will be electronically sent to your preferred pharmacy for pickup. Reasonable efforts will be made to ensure that urgent refill requests will be filled immediately. Reasonable efforts will be made to ensure that routine refills are processed within 48 business hours of your visit or request. Your Clinician may need to see you for an office visit/examination prior to prescribing or refilling medications.

Laboratory Orders. We will order medically necessary laboratory tests on your behalf. Labs are ordered when medically necessary, therefore your Clinician may require an office visit to evaluate your condition prior to ordering the lab.

Referrals. We work with a large network of specialists in the area and will refer you to the top specialists for your medical needs. Upon request, we will schedule appointments and coordinate consultations with your specialists. Your Physician may require you to come in for an office visit/examination prior to referring you to a specialist.

Paperwork & Forms. We will generally be able to fill out and mail/fax/email paperwork and forms within 48 business hours of request. At our discretion however we may require you to come in for an office visit/examination prior to us completing the paperwork.

SECTION 4 – EXCLUDED SERVICES

As part of the Heart of Wellness Optimal Health Service Agreement we only provide members Covered Services described in “Section 2 – Covered Services” and “Section 3 – Other Covered Services.” All other services are excluded. We do not provide, pay for, or in any way reimburse you for any other services (“Excluded Services”) including, but not limited to, the following: hospital care, hospitalizations, emergency care, surgery, blood draws, diagnostic testing, radiology or imaging, obstetrics, orthotics, prosthetics, podiatry, dental care, the cost of medications and supplements, services provided outside our offices, services provided by health care providers other Heart of Wellness employees or by an entity other than Heart of Wellness, or any services performed by Heart of Wellness Clinicians beyond what is specifically listed in Section 2 and Section 3 above.

SECTION 5 – MEMBERSHIP FEES AND BILLING

Registration Fee. A non-refundable $195 per patient registration fee is due upon signing. This is a one-time fee. You will only ever have to pay it once as long as your membership remains current.

Monthly Membership Fees:

  • Bronze: $95 per month
  • Silver: $145 per month
  • Gold: $195 per month
  • Platinum: $245 per month

We require that you set-up recurring electronic payments for your monthly membership fee using the enrollment link on our website. Your monthly membership fee will be processed and charged at the end of the monthly billing period unless your Heart of Wellness Optimal Health Service Agreement is terminated. Once you sign up online and your membership is confirmed, your first monthly fee will be charged on the card or account on file starting one month following your Effective Date and monthly thereafter. You hereby authorize us to make these charges or debits depending on the payment method you authorized through our website.

Payment Penalties. A $25.00 service fee will be charged if payment is returned for any reason (e.g. closed account, expired credit cards, insufficient funds.) Delinquent payments will be subject to a $25.00 late fee initially and $25 per month thereafter. In such event, members agree to owe the total late fee balance along with all past due monthly fees.

Change in Membership. Heart of Wellness may add/discontinue services or may increase/decrease membership fees at any time (but no more than once a year) after providing you at least a sixty (60) day notice of such changes.

Insurance. We do not bill insurance carriers for services performed for Heart of Wellness Optimal Health members. Members acknowledge that they will not seek reimbursement from any insurance carrier for the services specifically described in this Heart of Wellness Optimal Health Service Agreement, and that if they do so, inadvertently or otherwise, they may be in violation of both their insurance contract and the law.

SECTION 6 – MEMBERSHIP TERM AND TERMINATION

Membership Term. Your Heart of Wellness Optimal Health Membership is based on an annual term. The initial term of your membership starts on the Effective Date and continues for 1 year (12 months). At the end of the initial term, we will automatically renew your membership for subsequent 1 year (12 month) terms unless you cancel your membership.

Cancellations. You may cancel your membership at anytime for any or for no reason, but a written notification is required thirty (30) days prior to the upcoming scheduled payment due date. Please fill out the Service Cancellation Form and return it to our office by fax, email, or mail. Fees will continue to accrue until written notice is received.

Termination. Your Heart of Wellness Optimal Health Service Agreement may be terminated by us for any reason upon written notice, in compliance with all applicable regulations and licensing requirements which are imposed on licensed health professionals in the State of Washington.

Early-Cancellation and Re-Enrollment. Your continued enrollment in Heart of Wellness Optimal Health program represents a commitment to your ongoing health and wellness and ensures and to the affordability of our services. A $250 early termination fee will be charged if you cancel your membership prior to the end of the current enrollment year. If you decide to re-enroll you will need to re-enroll and pay the $195 per patient non-refundable registration fee again. You will also need to pay any unpaid remaining balance due. Heart of Wellness reserves the right to discontinue care and deny re-enrollment if it deems that your cancellation is an attempt to take unfair advantage of the membership system.

Decline of Enrollment. We may decline to accept enrollment if Heart of Wellness has reached its maximum capacity for Heart of Wellness Optimal Health members, or if the member’s condition is such that the provider is unable to provide the appropriate level and type of health care services. Heart of Wellness may discontinue care and terminate the Optimal Health Agreement in case of:

1) Non-payment or late-payment of fees under the terms required by the Heart of Wellness Optimal Health Service Agreement.

2) Member has performed an act that constitutes fraud.

3) Member repeatedly fails to comply with the recommended treatment plan.

4) Member is abusive and presents an emotional or physical danger to the Clinicians and Staff or other patients and members of Heart of Wellness.

5) Heart of Wellness no longer operates the Heart of Wellness Optimal Health Membership program.

As an enrolled member, you are entitled to care and service without discrimination that meets or exceeds the medical standard of care in the State of Washington.

SECTION 7 – MEDICARE/MEDICAID

It is your responsibility to determine and inform us in writing or by email of your enrollment in Medicare, Medicaid, or other government-funded insurance programs.

Medicare. None of the Clinicians at Heart of Wellness are contracted Medicare providers. We cannot bill Medicare for any services. By entering into this Service Agreement you represent that you will not seek reimbursement from Medicare for any services provided by Heart of Wellness or its Clinicians.

Medicaid. You represent that you are not enrolled in Medicaid. By law you cannot be a Heart of Wellness Optimal Health member and also be enrolled in Medicaid. if you enroll in Medicaid at any time during the term of your membership, this Heart of Wellness Optimal Health Service Agreement will be terminated on the date of your Medicaid enrollment.

SECTION 8 – PRIVACY, SECURITY, AND CONFIDENTIALITY OF PHI

Protected Health Information (PHI). We will maintain the privacy and confidentiality of all PHI about you in accordance with all applicable statutes and regulations. You also acknowledge receipt of Heart of Wellness’s HIPAA policy, as available here.

Members understand and agree that communications using email, fax, cell phone, text or video chat (“Electronic Communications”) are not guaranteed to be secure or confidential methods of communications. Although Heart of Wellness has implemented reasonable technical safeguards, it cannot guarantee the privacy, security, and confidentiality of PHI. As such, you expressly waive Heart of Wellness and your Clinicians obligations to guarantee confidentiality with respect to correspondence using such means of communication. Member understands that at the discretion of Heart of Wellness and your Clinicians, correspondence using such means of communication may be made part of your permanent medical record.

By providing your email address and cell phone number and agreeing to the Heart of Wellness Optimal Health Service Agreement, you authorize Heart of Wellness and its Clinicians and Staff to utilize Electronic Communications regarding PHI, as termed in the Health Insurance Portability and Accountability Act (HIPAA) of 1996 and its implementing regulation. By providing your email address and cell phone number and agreeing to the terms and conditions, you acknowledge that Heart of Wellness and its Clinicians and Staff will make all reasonable efforts to keep Electronic Communications confidential and secure, although neither Heart of Wellness, nor its Clinicians or Staff can assure or guarantee the absolute confidentiality of Electronic Communications.

Non-Response and Technical Failure. If you do not receive a response to any message within 48 hours, you agree to use another means of communication to contact Heart of Wellness and its Clinicians or Staff. Neither Heart of Wellness nor its Clinicians or Staff will be liable to member for any loss, cost, injury, or expense caused by, or resulting from, a delay in responding to member as a result of technical failures, including, but not limited to: technical failures attributable to any internet service provider; power outages, failure of any electronic messaging software, or failure to properly address e-mail messages; failure of Heart of Wellness’s computers or computer network, or faulty telephone or cable data transmission; any interception of Electronic Communications by a third party; member’s failure to comply with the guidelines regarding use of Electronic Communications set forth in this Heart of Wellness Optimal Health Service Agreement.

SECTION 9 – GENERAL PROVISIONS

If you are unsatisfied with the care you have received from Heart of Wellness, we request that you notify us immediately so that we may attempt to resolve your complaint quickly and in a way satisfactory to you. Please ask for Jeanette Cisneros, Clinic Manager. In the event of any controversy or dispute between you and Heart of Wellness related to or arising out of your Heart of Wellness Optimal Health Service Agreement membership, the parties agree to meet and confer in good faith to attempt to resolve the controversy or dispute without any adversary proceeding. Unresolved complaints may be brought to the attention of the Office of the Insurance Commissioner for the State of Washington by calling (800) 562-6900 or by email at cad@oic.wa.gov.

Assignment. Your Heart of Wellness Optimal Health Membership or any interest therein to any other person or entity may not be assigned or transferred.

Policies, Procedures, and Amendments. We may from time to time develop policies and procedures in connection with the operation or administration of the Heart of Wellness Optimal Health Agreement. We may also amend this Service Agreement, including the Covered Services and Other Covered Services from time to time. A written notice to the member will be provided to inform of any changes.

General Release. To the greatest extent enforceable by law, each member, on behalf of himself or herself and each of their respective heirs, beneficiaries, successors and assigns, hereby forever releases and discharges Heart of Wellness, its affiliates, directors, and each of their employees and representatives from and against any and all liabilities, claims, demands, actions, and cause of action of any kind or character that such person has, or may have relating to or arising from use of services under the Heart of Wellness Optimal Health Service Agreement. The sole recourse available to any such releasing person against Heart of Wellness is termination of your Heart of Wellness Optimal Health Service Agreement membership in accordance with these Membership Term and Conditions.

Waiver. The waiver by Heart of Wellness of any breach of any provision of these terms and conditions by member will not operate or be construed as a waiver of any subsequent breach by member.

Notices. All notices, consents, approvals, requests, and communications required under these terms and conditions and this Heart of Wellness Optimal Health Service Agreement shall be in writing and shall be deemed to have been given when delivered by first class mail, postage prepaid or by hand delivery to you at the most recent address shown in our records and to us at: Heart of Wellness, 205 Clark Place SE, Tumwater, WA 98501.

Severability. Any provision of these terms and conditions that is held to be inoperative, unenforceable, voidable or invalid in any jurisdiction will, as to that jurisdiction, be inoperable, unenforceable, void or invalid without affecting the remaining provisions of these terms and conditions in that jurisdiction or the operation, enforceability or validity of that provision in any other jurisdiction, and to this end, the provisions of these terms and conditions are declared to be severable.  Any provision of these terms and conditions that is held to be inoperative, unenforceable, voidable or invalid will be enforced to the maximum extent permitted under applicable law.

Regulatory Compliance. It is the intent of Heart of Wellness that this agreement comply in all respects with all applicable federal, state, and local laws. In the event that any provision of these terms and conditions is rendered invalid or unenforceable by a court of competent jurisdiction, or the applicable laws and regulations are altered by any legislative or regulatory body, or member is notified in writing of Heart of Wellness’s reasonable belief that these terms and conditions or any of its provisions may be declared null, void, unenforceable, or in violation of applicable laws or regulations, the remaining provisions, if any, of these terms and conditions will nevertheless continue in full force and effort.