By consenting to participate in Remote Therapeutic Monitoring (RTM) services, you acknowledge that you have read, understood, and agree to the following terms:
- Potential Copayment Requirements:
You understand that your participation in RTM services may involve a copayment or other out-of-pocket expenses. The exact amount will depend on your specific health insurance coverage. We encourage you to contact your insurance provider for further details regarding any potential costs. - Voluntary Participation and Cancellation:
Your participation in RTM is entirely voluntary. You have the right to withdraw from the RTM program at any time, for any reason, without affecting the quality of care you receive from your healthcare provider. If you choose to discontinue, simply notify us, and we will cease RTM services promptly. - Sharing of Care Information:
You consent to the sharing of your health information with other healthcare providers involved in your care, as needed. This sharing of information aims to facilitate comprehensive and coordinated management of your health and ensure the highest standard of care. - Single Practitioner Billing for RTM Services:
Under current regulations, only one healthcare practitioner may bill for RTM services at a time. By participating in this program, you acknowledge that billing for RTM will be limited to a designated practitioner responsible for your remote monitoring. This practitioner will be coordinating your care as part of the RTM program.
We are committed to protecting your privacy and maintaining the confidentiality of your health information in accordance with our Privacy Policy. Should you have any questions about this consent agreement, please contact us for further information.
By accepting this agreement, you affirm your understanding and consent to the terms outlined above for participation in RTM.