FELLA DIRECT HEALTH CARE PROGRAM MEMBERSHIP AGREEMENT
This Agreement sets forth the terms of your membership in Fella’s Direct Health Care Program (“Program”), with Fella Medical Group, P.A., a Florida professional medical corporation (“Fella Medical” or “Practice”). The Program is designed to provide you with direct personalized treatment for obesity in exchange for certain fees paid by you on the terms and conditions described below.
NOT HEALTH INSURANCE. THIS AGREEMENT IS NOT HEALTH INSURANCE AND DOES NOT MEET ANY INDIVIDUAL HEALTH INSURANCE MANDATE THAT MAY BE REQUIRED BY FEDERAL LAW, INCLUDING THE FEDERAL PATIENT PROTECTION AND AFFORDABLE CARE ACT AND COVERS ONLY LIMITED ROUTINE HEALTH CARE SERVICES AS DESIGNATED IN THIS AGREEMENT
BINDING ARBITRATION. THIS CONTRACT CONTAINS A BINDING ARBITRATION PROVISION WHICH MAY BE ENFORCED BY THE PARTIES
1. Program Services.
a) In exchange for the Monthly Membership Fee, as that term is defined herein, the Practice agrees to provide the following services: initial evaluation, ongoing management of your care, medication prescribing when appropriate, access to the Practice medical team when necessary in connection with ongoing care, access to the Fella platform, when it becomes available, and synchronous and asynchronous health coaching (collectively, the “Services”). The scope of all Services is strictly limited to treatment for obesity.
b) Practice will make every effort to address your medical needs in a timely manner, but we cannot guarantee availability. Generally, Practice will respond within twenty-four (24) hours to communications that are received on a business day, and forty-eight (48) hours for other communications.
2. No Emergency Care; Certain Services and Items Excluded.
If you have an emergency you must dial 911. Practice does not treat emergencies. Practice exclusively provides treatment for obesity and weightloss, therefore, no other healthcare services are contemplated or covered by this Agreement.
a) Membership Fee. In exchange for the Services described above, you agree to pay Practice a Membership Fee (“Membership Fee”) as stated during initial sign up per month for the duration of your membership. The Membership Fee is due in advance for each month you participate in the Program, and is due monthly on the anniversary of your intake appointment (the “Payment Date”). Once paid, your Membership Fee is non-refundable, except as outlined here: https://www.fellahealth.com/refund-policy.
b) Fee Changes. Practice has the right to change the Monthly Membership Fee upon providing 90 days’ written notice to you before fee changes are enacted.
c) Valid Payment. You are required to keep a valid form of payment on file with Practice or its vendor at all times. If the form of payment provided expires or otherwise becomes invalid, you agree to promptly provide Practice with updated payment information. You further agree to pay for any costs associated with invalid payments or payment information, including but not limited to insufficient funds or chargeback fees.
d) Re-Enrollment. If you choose to discontinue your membership and you later wish to re-enroll, you may do so at any time.
4. No Insurance Accepted; Self-Payment Only.
You acknowledge and understand that this Agreement is not health insurance or a health plan. The fees paid under this Agreement are not insurance premium. This Agreement is not a substitute for health insurance or other health plan coverage, and it does not meet any individual health plan mandates. This Agreement is not subject to regulation as health insurance or a health plan, and no protections are available to you with respect to this Agreement under state insurance law. This Agreement is solely for obesity treatment provided directly to you by Practice. This Agreement does not cover regular primary care, hospital, specialist, or any other services not directly provided by Practice. Some health insurance plans may offer specific care with no charge to you that is similar to some of the Services offered by Practice. You should maintain health insurance or health plan coverage for such care.
You acknowledge that neither Practice, nor its physicians and other providers participate in any public or private health insurance, HMO or similar plans, including Medicare and Medicaid. Neither Practice nor its physicians make any representations regarding third party insurance reimbursement of Fees paid under this Agreement, and such reimbursement is not anticipated by this Agreement. Practice will not bill any health insurance or health plan for Services.
You are solely responsible for payment of all fees for Practice’s Services. If you do have health insurance, your insurance policy is a contract between you and your insurance company. It is your responsibility to know your benefits, and how they will apply to your benefit payments. Practice takes no responsibility to understand or be bound by the terms and conditions of such insurance. There is no guarantee your insurance company will make any payment on the cost of the services you have purchased.
5. Subscription Billing.
In order to participate in the Program, your Membership Fee payments will be charged to your credit card on a recurring basis. You hereby agree to allow Practice to securely store your credit / debit card information (the “Payment Method”). You authorize the Payment Method to be used automatically for your payment responsibilities to Practice. If a credit card account is being used for a transaction, Practice may obtain preapproval for an amount up to the amount of the payment. If you want to designate a different payment method or if there is a change in your Payment Method information, you can change the information with Practice by contacting your care coordinator. This may temporarily delay your ability to make online payments while Practice verifies the new payment information. You represent and warrant that: (1) any credit / debit card information you supply is true, correct and complete, (2) charges you incur will be honored by your credit/debit card company, (3) you will pay the charges incurred in the amounts posted, including any applicable taxes, and (4) you are the person in whose name the credit / debit card was issued and are authorized to make a purchase or other transaction with the relevant credit / debit card and information. You agree and authorize the Payment Method to be billed automatically in an amount equal to the Membership Fee in effect for your Membership Term.
If Practice is unable to secure funds from your debit / credit card(s) for any reason, including, but not limited to, insufficient funds in the debit / credit card or insufficient or inaccurate information provided by you when submitting electronic payment, Practice may undertake further collection action, including application of fees to the extent permitted by law.
You have the right to revoke this authorization by contacting Practice at firstname.lastname@example.org at least five (5) days prior to the scheduled payment date. You understand that your Membership may be cancelled or withheld if you revoke this authorization, and you are still responsible for all charges you incur or otherwise owe to Practice. This authorization will remain in full force and effect until revoked by you or Practice.
6. Term and Termination.
Term. Practice may, in its sole discretion, not accept this Agreement and return your payment to you. If Practice accepts the Agreement, it will so notify you, and the initial term of this Agreement will begin on the date Practice receives your Membership Fee payment and last for the length of the Membership Term you selected (“Initial Term”). After the Initial Term, this Agreement will automatically renew for successive Membership Terms of identical length (each, a “Renewal Term”), unless this Agreement is terminated as provided below.
Termination. Either you or Practice may terminate this Agreement at any time, with or without cause, upon thirty (30) days’ prior written notice. Upon notice of termination, you will be entitled to receive the Services until the effective date of termination.
7. Electronic Communications.
By providing your email address, phone number, and agreeing to the terms of this Agreement, you hereby consent to receive electronic communications via email, phone calls, and SMS text messages related to the membership services provided.You acknowledge and consent to the recording of phone calls made to or received from our membership program. These recordings will be used solely for your program enhancement and quality assurance
8. Privacy and Confidentiality.
Practice and its providers will maintain a record of the services they provide you, and will maintain the confidentiality of your medical information in accordance with applicable state law and federal law.
9. Entire Agreement; Amendment.
This Agreement sets forth the entire agreement between the parties with regard to the subject matter hereof, and supersedes all prior or contemporaneous oral or written agreements. This Agreement may be amended only in writing signed by all parties. Notwithstanding the foregoing, Practice may, upon at least ninety (90) days’ notice to you, unilaterally amend the Membership Fee at any renewal period of this Agreement and/or amend this Agreement if required by applicable law. Upon receipt of such notice, you may accept these changes or reject them by immediately terminating your Membership in accordance with Section 6 (Termination).
10. Miscellaneous. Governing Law.
This Agreement shall be governed by and construed in accordance with the state laws specified in the applicable State Addendum. Venue. The exclusive forum for all disputes arising under or relating to this Agreement, shall be in Florida, unless such action cannot by law be brought in such forum, in which case the venue required by law shall govern. Anti-Referral Laws. Nothing in this Agreement, nor any other written or oral agreement, nor any consideration in connection with this Agreement, contemplates, requires, or is intended to induce or influence the admission or referral of any patient to, or the generation of any business between, the parties or any other entity. This Agreement is not intended to influence any provider’s professional judgment in choosing the appropriate care and treatment of patients. Waiver. The failure of a party to insist upon strict adherence to any term of this Agreement on any occasion shall not be considered a waiver or deprive that party of the right thereafter to that term or any other term of this Agreement. Severability. The invalidity or unenforceability of any term or provision of this Agreement shall not affect the validity or unenforceability of any other term(s) or provision(s). Successors. This Agreement shall be binding upon and shall inure to the benefit of the parties and their respective successors, assigns, heirs, executors and administrators. No Assignment. You may not assign your rights, duties and obligations under this Agreement without the prior written consent of Practice, whose consent may be withheld for any reason. Any attempt to assign said rights, duties and obligations without the prior written consent of Practice will be null and void and of no force or effect. Practice may assign this Agreement with thirty (30) days in advance to you. Counterparts. This Agreement may be executed electronically in one or more counterparts, all of which together shall constitute only one agreement. State Addendum. The applicable State Addendum shall be incorporated herein. The terms of this Agreement and the State Addendum shall be read in harmony but, in the event of an irreconcilable conflict between the two, the conflicting terms of the State Addendum shall control. Notices. Any communication required or permitted to be sent under this Agreement shall be in writing and sent via electronic mail (a) to Practice at email@example.com and (b) to you at the email or the address you designate at signature.
State Addendum: Texas
By signing this, I have read, understand, and agree to the terms of this Agreement.