General Service Terms
Standard Disclosures/Notices
For Intro, Basic, Single, Consultative,
& Remote/Telehealth Services
Current VID 9-1-25
In accordance with HIPAA regulations specific to the state of Florida, The Healing House is committed to the privacy/security of protected health information (PHI). Access to comprehensive Privacy Practices, detailing how PHI may be used and/or disclosed, is outlined/linked below & available upon request.
This Services Agreement (“Agreement”) is between TMS Therapy Clinic of Orlando, LLC, doing business as The Healing House, as well as its authorized/contracted Affiliates or Providers (“Healing House,” “HH”, “Practice”, “Facility”, "Provider", or “Team”), and the inquiring or active Care Recipient as well as their authorized Guardian (If Under 18 years old), Friends/Family, & Affiliates (“Candidate”, “Prospect”, “Client”, “Patient/Client”, or "Pt/Client") who are involved with HH treatments/services and/or who are assuming financial responsibility at HH. Delivery of Care (“Treatment”, “Tx”, “Service”, or “Care”) may be on-site at the primary location of 1199 N Orange Ave. Orlando, FL 32804 or otherwise hosted/administered by HH via third-party sites and/or platforms.
*1. Intro to Services / Agreement
HH offers and supervises integrative behavioral care as well as medical, health, & wellness sessions/programs on an outpatient basis. This Agreement declares the terms and conditions pertaining to ‘Basic/Standard’ administrative & intake processes and to General introductory, single session, bundled ‘Thrive’, consultative, remote & telehealth, and/or promotional Services being administered by HH to Pt/Client. Such Tx is conducted on-site at HH’s primary location or is hosted by HH personnel through secure third-party technologies and/or at an off-site physical location that is approved by HH.
By recognizing this Agreement, both parties set forth the mutual understanding of a therapeutic relationship according to the above. HH’s 'General' Tx offering shall include but is not limited to administrative duties, intake/onboarding workups, payment schedules, financial/collections management, integrative care solutions, and clinical/device sessions. These offerings are expanded upon & further outlined below and in HH’s Master Services & Financial Agreement (MSFA) for intensive Tx plans, referred to as ‘Program’ Care.
The following 'Commitment to Care' terms apply to every Candidate's Basic/Standard intake for Services and to all Pt/Clients who are engaging in any form of HH Care. Advanced intake for Program Tx references & observes the same core policies.
General Treatment Consent,
Notice of Privacy, & Standard Tx Guides:
Commitment to Care
Search: hhbrainhealth.com/general
> Commitment to Care
*2. Care Model & Financial Arrangement
Treatment offered/provided at HH is subject to Out-of-Network (“OON”) Facility Status on a Fee-for-Service (“FFS”) basis. Services will be considered Non-Covered/Self-Pay (“NC/SP”) unless otherwise specified by a written agreement with HH, pursuant to qualified benefits & coverage options. Any appropriate standard pricing for FFS Gen. Tx is issued during HH intake/onboarding processes for qualified Candidates or Prospects. FFS Tx does not require a written Fin. Breakdown or Care Quote (FB/CQ) and HH’s standardized Fee Schedule including Promotions & Discounts (P&D) will apply. This pricing factors in Goodwill Qualifiers and may be presented by HH via shorthand materials and/or verbal care quotes. Pt/Client must designate a Responsible Financial Party (“RFP”) for any forecasted HH Services. If a consultation has occurred, it may be determined that Pt/Client is qualified for Program Care, at which point a FB/CQ is issued according to the terms of HH’s MSFA. HH requires a valid & sufficient primary credit card on file from a designated RFP to schedule and proceed with any Care. Payments are collected upfront & in-full unless a payment schedule is approved by HH for in-house and/or third-party financing (typically for Program Tx). Any multi-payment financing arrangement may be treated by HH as Program Tx (MSFA terms). Cards on file are charged prior to or at the time of Care based on a Tx plan's single-unit credit allottments unless terms are agreed upon for scheduled payment installations. Standard fees apply for clinician or technician appointments if cancelled without 24-hour (business days) notice to HH, unless waived for a medical emergency or approved for a rescheduling fee. Service credits may be recognized by HH in the instances of Tx discontinuation, Care settlement, and/or P&D offerings. Any honored Tx credit(s) will expire after 1 calendar year. Variable terms & policy updates may apply to future HH Care.
*3. Insurance Coverage Expectations
HH is not directly contracted with any insurance payor (Carrier). This means HH is not considered an In-Network (IN) provider of Services. HH does however accept a variety of insurance plans for certain Pre-Authorized Tx that Carriers consider ‘Higher-Level’ procedures. For such cases, coverage must be approved by the respective Carrier of an active Member/Policyholder and also by HH prior to the initial Date of Service (DOS). HH will verify health and/or medical benefits on behalf of Pt/Client once permitted. This process allows HH to confirm the designated Policyholder’s active Member/Network statuses according to private investigations via contracted third parties. Applicable coverage variables of Member’s policy are reflected in FB/CQ, and coverage approvals are predicated on Carrier’s specific criteria for ‘Medical Necessity’. A criteria summary may be issued during clinical/financial intake as it is made available by Carrier.
Pre-authorized coverage is also subject to Provider/Network status as it relates to Facility on a case-by-case basis, and this may be determined by Carrier at time of reimbursement. Select NC/SP Services that do not require Pre-Authorization may be eligible for OON reimbursement via Superbill (SB) at HH’s discretion. HH does not accept assignment for OON reimbursement and may issue adjusted Tx credit(s) in the scenario of such errors. Full billable rates apply. P&D and/or credited Tx is ineligible for OON coverage.
*4. Mutual Obligations / Responsibilities
Pt/Client will provide and keep current accurate & complete profile, demographics, financial, & insurance information, will adhere to policies, scheduling, & treatment plans, and will comply with service/payment agreements, all of which involves engaging with HH’s required technology platforms. HH will deliver comprehensive services, will qualify & host all Tx/devices/providers, will submit approved DOS claims, and will maintain a professional environment that is in compliance with privacy/confidentiality.
*5. Amendments, Termination, & Disputes
This Agreement must be executed by Pt/Client and observed by both parties to best meet clinical standards and to always ensure safety requirements. Either party may terminate this working relationship at any time, subject to the settlement of any outstanding fees and/or obligations. HH obligations may be negated if Pt/Client is clinically discharged. Any disputes arising from this Agreement shall be resolved through mediation and/or arbitration in the state of Florida.
*6. Acknowledgment and Acceptance
By signing & submitting CP/Demo, Pt/Client (or Guardian) acknowledges, understands, and agrees to the terms set forth by HH that are outlined/linked in this Agreement.