Terms & Conditions
HOW TO CONTACT EXOGEAR
Please call Exogear during normal business hours at 1-833-396-4327. If you call after normal business hours, an answering service will take you message and a company representative will contact you on the next business day. Our mailing address is: 140 School St. Kenmore, NY 14217
USE OF PRODUCT:
Patient agrees to use this product only in the manner for which it was intended and will not attempt to make any modifications or changes of any kind to the product. This product is provided to you, by your health provider by prescription only. This product is to be utilized only as directed by your health care provider. Exogear makes
no recommendation for use. Any questions about your medical condition or benefits of this product should be directed to your health care provider. I acknowledge that I have been trained on and understand the proper operation, care, handling, safety, storage and disposal of the device(s). For Medicare Patients Only: I acknowledge that I have not received the same or similar product while covered by Medicare.
Exogear does not accept returns of dispensed items. Items may be returned for replacement due to size or defect.
All equipment purchased, rented or leased as “new” from the company will be in good working order according to manufacturer’s specifications. All new equipment is warranted by the facility for a period of thirty (30) days from the date of purchase or home delivery. The company will assist the client, as necessary and appropriate, to
facilitate the reimbursement or equipment replacement pursuant to all equipment manufacturers warranties. The company will provide or arrange for loaner equipment equivalent to the original equipment during any repair period except for orthotics and prosthetics.
PATIENT HAS A RIGHT TO:
Be treated with dignity, courtesy and respect. Have relationships with home medical equipment providers that are based on honesty and ethical standards of conduct. Reasonable coordination and continuity of services from referring agency to home medical equipment service provider, timely response when home care equipment is needed or requested and to be informed in a timely manner of impending discharge. Be fully informed upon admission of the company policies, procedures, ownership or control of the local facility and the process for receiving, reviewing and resolving your complaints or concerns. Receive complete explanations of charges for services and equipment, including eligibility for third-party reimbursement and an explanation of all forms you are requested to sign. Receive quality home care equipment and services that meet or exceed professional and industry standards regardless of race, religion, political belief, sex, social status, age or disability. Receive home care equipment and services from qualified personnel and to receive instructions on self-care, safe and effective operation of equipment and your responsibilities regarding home care equipment and services, including pain and pain management modalities. Participate in decisions concerning the nature and purpose of any technical procedure which will be performed and who will perform it, the possible alternatives and/or risks involved and your right to refuse all or part of the services and to be informed of expected consequences of any such action. Confidentiality of all your records (except as otherwise provided for by law or third-party payer contracts) and to review and even challenge those records and to have your records corrected for accuracy. Express dissatisfaction and to suggest changes in any service without discrimination, reprisal or unreasonable interruption of services. Be advised of the telephone number and hours of operation of the state’s Home Health “Hot Line.” The hours are 9 AM to 5 PM and the number is 1-800-628-5972. Be advised of any change in the plan of care before the change is made. Participate in the planning of the care and in planning changes in the care, and to be advised that you have the right to do so. Accept or refuse medical treatment while competent and to make decisions about care/services to be received should you lose competency.
PATIENT HAS A RESPONSIBILITY TO:
Adhere to the plan of treatment or service established by their physician. Participate in the development of an effective plan of care which will involve the management of pain, if appropriate. Provide medical and personal information necessary to plan and provide services. Communicate any information, concerns and/or questions related to pain. Be available at the time deliveries are made. Treat company personnel with respect and dignity without discrimination. Provide a safe environment for staff to provide care and services. Care for and safely use equipment.
If litigation is instituted to collect any unpaid balance, I agree to pay all costs, including reasonable attorney’s fees, incurred by EXOGEAR.
PATIENT HAS A RIGHT TO:
According to instructions provided, for the purpose it was prescribed and only for/on the client for whom it was prescribed. Protect equipment from fire, water, theft or other damage. The client agrees not to transfer or allow his/her equipment to be used by any other person without prior written consent of the company and further agrees not to modify or attempt to make repairs of any kind to the equipment. Except where contrary to federal or state law, the client is responsible for equipment rental and sale charges which the client’s insurance company or companies does not pay. The client is responsible for settlement in full of his/her accounts. The company should be notified of any changes in the client’s physical condition, physician’s prescription or insurance coverage. Notify the company immediately of any address or telephone changes whether temporary or permanent.
PATIENT FINANCIAL RESPONSIBILITY:
By accepting this product, the patient understands and acknowledges responsibility for all charges that are not covered by insurance. Every effort will be made to notify the patient of any coinsurance, copay or deductible. Amounts provided to the patients are an estimate only. There is no guarantee of payment by my insurance company. It is solely the patient’s responsibility to contact their insurance company if there are any questions about potential financial obligations for the product. Exogear is not responsible for misinformation given by insurance companies regarding benefits.
NOTICE OF PRIVACY PRACTICES:
This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully. We are required by law to provide you with this notice explaining our privacy practices with regard to your medical information and how we may use and disclose your protected health information (PHI) for treatment, payment, and for health care operations, as well as for other purposes that are permitted or required by law. You have certain rights regarding the privacy of your protected health information and we also describe planning your care and treatment, means of communication among the many health professionals who contribute to your care, legal document describing the care you received, means by which you or a third-party payer can verify that services billed were actually provided, a tool in educating health professionals, source of data for medical research, source of information for public health officials charged with improving the health of the nation, source of data for facility planning and marketing, a tool with which we can assess and continually work to improve the care we render and the outcomes we achieve.
UNDERSTANDING WHAT IS IN YOUR RECORD AND HOW YOUR HEALTH INFORMATION IS USED HELPS YOU TO:
Ensure its accuracy, better understand who, what, when, where, and why others may access your health information, make more informed decisions when authorizingdisclosure to others.
HOW THIS OFFICE MAY USE OR DISCLOSE YOUR HEALTH INFORMATION:
This company collects health information about you and stores it in a chart and on a computer. This is your medical record. The medical record is the property of this medical practice, but the information in the medical record belongs to you. The law permits us to use or disclose your health information for the following purposes: Treatment: We will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. We may provide your physician or a subsequent health care provider with copies of various reports that should assist him or her in treating you. Payment: We will use and disclose your protected health information to obtain payment for the health care services we provide you. For example, we give your health plan the information it requires before it will pay us. We may also disclose information to other health care providers to assist them in obtaining payment for services they have provided to you.
OTHER WAYS WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION:
Should we call and you not be at home, we may leave minimally necessary information to accomplish our purposes with a family member, significant other, or in an e-mail, voice mail, texting device, or answering machine. In the event of a disaster, we may disclose information to a relief organization so that they may coordinate these notification efforts. We may also disclose information to someone who is involved with your care or helps pay for your care. Future communications: We may communicate to you via newsletters, mailings or other means regarding treatment options, information on health- related benefits or services; or other community based initiatives or activities in which our facility is participating. If you are not interested in receiving these materials, please contact our Privacy Officer. Required by law: As required by law, we may use and disclose your health information, to the following types of entities including but not limited to: • Public health authorities for purposes related to: preventing or controlling disease, injury or disability; • Authority that receives reports on abuse or neglect or reporting domestic violence; • Food and Drug Administration • Health oversight activities-we may, and are sometimes required by law to disclose your health information to health oversight agencies during the course of audits, investigations, inspections, licenser and other proceedings, subject to the limitations imposed by federal and state law. • Law enforcement/legal proceedings-we may disclose health information for law enforcement purposes as required by law or in response to a subpoena • Coroners • Organ or tissue donation • Public safety • Specialized government functions such as: national security and intelligence agencies, Worker’s Compensation, Inmates, Research.
HEALTH CARE OPERATIONS:
We may use and disclose medical information about you to operate this medical practice. For example, we may use and disclose this information to review and improve the quality of care we provide, or the competence of our professional staff. We may also use and disclose this information as necessary for medical reviews, legal services and audits, including fraud and abuse detection and compliance programs and business planning and management. We may also share your medical information with our “business associates,” such as software support, billing, and collections companies. We have a written contract with each of our business associates that contains terms requiring the business associates and any subcontractors they may hire to protect the confidentiality of your medical information.
I authorize EXOGEAR or its Business Partners to submit a claim tor such product(s) to my insurer on my behalf, and I assign the benefits payable by my insurer for such product(s) to EXOGEAR or its Business Partners. I authorize my health care provider and EXOGEAR, or its Business Partners to release any of my medical information required tor treatment and health care operations for my insurer to process the claim. I acknowledge and authorize EXOGEAR or its Business Partners to deliver, teach, administer or perform as necessary, the product(s) and services prescribed by my health care provider, and I acknowledge that I have received the product(s) and such services. I also authorize EXOGEAR to contact me directly through my mobile phone using an automated dialer or broadcast messaging for additional information that may be needed to process my claim and or a past due balance on my account.
CHANGE OF OWNERSHIP:
In the event that this medical practice is sold or merged with another organization, your health information/record will become the property of the new owner, although you will maintain the right to request that copies of your health information be transferred to another provider. Breach Notification: In the case of a breach of unsecured protected health information, we will notify you as required by law. In some circumstances our business associate may provide the notification.
USES OR DISCLOSURES NOT COVERED BY THIS NOTICE:
Uses or disclosures of your health information not covered by this notice or the laws that apply to us may only be made with your written authorization. You may revoke such authorization in writing at any time and we will no longer disclose health information about you for the reasons stated in your written authorization. Disclosures made in reliance on the authorization prior to the revocation are not affected by the revocation.
Although your health record is the physical property of the facility that compiled it, the information belongs to you. You have the right to: Request an Amendment: You have the right to request that we amend your medical information if you feel that it is incomplete or inaccurate. You must make this request in writing to our Privacy Officer. Request Restrictions: You have the right to request a restriction of how we use or disclose your medical information for treatment, payment, or health care operations. Your request must be made in writing. If a patient pays in full for their services out of pocket they can request that the information regarding the service not be disclosed to the patient’s third party payer since no claim is being made against the third party payer. Inspect and Copy: You have the right to inspect and copy the protected health information that we maintain about you in our designated record set for as long as we maintain that information. You have the right to access your own e-health record in an electronic format and to direct Exogear to send the e-health record directly to a third party.
MEDICARE DMEPOS SUPPLIER STANDARDS:
The products and/or services provided to you by Exoskeletal Technologies, LLC, DBA: Exogear are subject to the supplier standards contained in the Federal regulations shown at 42 Code of Federal Regulations Section 424.57(c). These standards concern business professional and operational matters (e.g. honoring warranties and hours of operation). The full text of these standards can be obtained at http://www.ecfr.gov Upon request we will furnish you a written copy of the standards.
All customers have the right to lodge complaints without fear of discrimination or reprisal and to know the disposition of complaints. The organization has the responsibility to respond to those complaints promptly and to resolve complaints whenever possible to the satisfaction of the individual. All complaints shall be investigated within five (5) days and within fourteen (14) days provide written resolution of the investigation to the beneficiary. Should you wish to lodge a complaint or provide compliments about our products or services please call us at (833) 396-4327. If your complaint is not resolved by calling us, you may call one of the following numbers: New York State Insurance Hotline (1-888-372-8369) or our Accrediting Organization – BOC (1- 877-776-2200).
EXOSKELETAL TECHNOLOGIES, LLC (DBA EXOGEAR) 140 SCHOOL ST. KENMORE, NY 14217
ATTN: CORPORATE COMPLIANCE, PRIVACY OFFICER PHONE: (833) 396-4327