1. Medical Information Authorization: Customer authorizes any holder of medical information relating to said Customer to release to Reliable Respiratory any record pertaining to his or her medical history, services rendered, or treatment. Customer authorizes Reliable Respiratory to release Customer’s medical information to appropriate accreditation and insurance company personnel and other health care related organizations. Customer authorizes use of email to communicate with these organizations.
2. Financial Responsibility and Communications Consent: Customer understands that insurance coverage is not guaranteed and remains responsible for all amounts not paid by insurance, including denied claims, copayments, deductibles, coinsurance, and other non-covered charges. Customer authorizes Reliable Respiratory to charge the credit card on file for such amounts. Any balance that remains unpaid more than fourteen (14) days after the due date may be subject to collection efforts, and Reliable Respiratory may require the return of equipment until the account is paid in full.
3. Customer also authorizes Reliable Respiratory and its service providers to contact Customer by non-automated, automated, or AI-assisted calls, text messages, emails, and other digital communication channels regarding care, therapy, resupply, scheduling, billing, payment, and provider coordination. Calls may be recorded. Consent to receive such communications is not a condition of receiving care or services. Message and data rates may apply. Customer may opt out of marketing or non-essential communications at any time by replying STOP, using an unsubscribe option, or contacting Reliable Respiratory.
4. Assignment of Insurance Benefits: Customer authorizes any and all Medicare, Medicaid, or other insurance benefits to be paid directly to Reliable Respiratory for any equipment or services furnished to Customer by Reliable Respiratory.