Common use of Terms and Exclusions Clause in Contracts

Terms and Exclusions. I understand that the Annual Membership Fee payable to PPC Atlanta strictly covers healthcare services that are not consistently reimbursed or offered through the Medicare, Medicaid and third-party payors (health insurance) programs. As such, PPC Atlanta will not seek reimbursement for services provided as part of my Annual Membership Fee from Medicare, Medicaid, or any other third-party payer. I understand that I am solely financially responsible for payment of my Annual Membership Fee and that this fee is not reimbursable by my private insurance carrier, Medicare or Medicaid. However, the fees for my annual membership fee may be submitted to my health savings account 3 First degree family members include spouse or domestic partner, parent, sibling or child 4 If terminating from the program you must sign a HIPAA compliant request to have your records transferred to your new physician. One copy of your records will be provided to your physician at no charge. Any additional copies of your records will be charged for at then current rates. 5Failure to renew or to make quarterly payment in a timely fashion will be taken as your decision to immediately establish yourself with a new physician. ▇▇. ▇▇▇▇▇▇▇▇▇▇ will provide emergency care only for 30 days after your termination from the program. After this time ▇▇. ▇▇▇▇▇▇▇▇▇▇ will no longer be responsible for any aspect of your medical care and you should see your new physician for all medical issues. You and/or your insurance company as the case may be, will be responsible for any charges incurred for emergency care provided during this time. (HSA), medical savings account (MSA) or flexible benefits account (FBA) for reimbursement. I understand that I, or my insurance company, am responsible for all healthcare services that are traditionally covered by a health insurance program. These services exclude the services that are provided under my Annual Membership Fee. Regardless of health coverage, I understand that all co-payment, co-insurance and/or deductibles will apply as defined by my insurance policy. PPC Atlanta will bill my Payor for those services. In the event that the services are not covered by my Payor I understand that I am responsible for payment.