This is a notice to patients of United Medical Group, PLLC, a physician group that provides telehealth services through the website www.yourmd.online.

This notice serves as a disclosure of our Health Insurance Portability and Accountability Act (HIPAA) policies and our financial policy. We encourage you to review this notice carefully.

HIPAA Disclosure:

We are required by law to maintain the privacy of protected health information and to provide individuals with notice of our legal duties and privacy practices with respect to protected health information. We are required to abide by the terms of this notice. We reserve the right to change our practices and to make the new provisions effective for all protected health information that we maintain. We will provide individuals with a copy of any revised notice.

Financial Policy:

We will gladly bill your primary insurance for our services. Please note that insurance benefits must be determined prior to your exam and that eligibility verification does not guarantee coverage once the claim is filed. If you become aware of insurance coverage after services have been rendered, you agree to personally submit the claim to your insurance company for reimbursement. Our services are aimed at providing you with the best care possible, regardless of insurance. Payments for all services rendered by United Medical Group are the responsibility of the patient. Regardless of the amount or type of insurance you or your employer has purchased, each patient assumes full responsibility for all fees incurred. You are responsible for all charges not paid by your insurance carrier, if any required treatment, testing, or consultation is denied or applied to your dollar deductible the fee will become your responsibility. If a check is returned by the bank, there will be a $20 fee added to the unpaid balance, and it must be paid by cash or credit card.

We also would like you to list any authorized person(s) with whom we can discuss your appointments, insurance, and/or payments with (i.e. spouse, parent, etc.) Name of Authorized Person(s): Relationship to Patient

By providing this notice, United Medical Group, PLLC is complying with its notice of privacy practices under HIPAA and is informing the patient of our financial policy.