This document describes how we treat your personal information, explains how we handle your bank card, and describes your financial responsibilities and how you may use the ZOOM+ website and electronic services.
ZOOM+ Customer Agreement
Updated March 29, 2015
ZOOM+ is recognized for our fair, simple pricing and for our mission of providing On-Demand healthcare 365 days per year in neighborhood clinics. In order to provide you with On-Demand healthcare at a fair price, we need an honest, clear, and direct financial relationship with you. We serve you directly, not your insurance company. As a result, you are ultimately responsible for paying for your care. The following policies explain how ZOOM+ bills and collects payment for our services.
Use of Your Bank Card
When I schedule a visit at ZOOM+ clinic, I understand I am reserving a dedicated appointment time. ZOOM+ requires that a credit (or debit) card be kept on file in order to schedule appointments. We retain this information securely on file until your card expires in order to cover any costs related to this or any additional treatments or services you receive at ZOOM+. Scheduling an appointment with ZOOM+ and acknowledging this policy implies consent for us to retain your card information and charge up to, but not more than, $500.00 per transaction for any treatment fees, pharmacy fees, and other fees related to your care.
No Shows and Late Policy
By acknowledging this policy, I authorize ZOOM+ to keep my signature on file and to charge my credit/debit card up to $99 if I fail to show up for my appointment, or if I cancel with less than 1 hour of notice for Illness/Injury, Well Exam, and Naturopathy or less than 24 hours for all other services, or if I arrive late and do not reschedule another reservation for the same day. This is a Non-Refundable Fee. For the Video Visit via Skype, I understand I am reserving a dedicated appointment time with a ZOOM+ Provider who will be calling me at the specified time to care for me. By acknowledging this policy, I authorize ZOOM+ to keep my signature on file and to charge my credit/debit card $35 once my Video Visit is scheduled. If I fail to show or if I cancel with less than 1 hour of notice, I authorize ZOOM+ to charge my credit/debit card up to $35 as a missed appointment fee. This is a Non-Refundable Fee.
Acknowledgment of Financial Responsibility
I acknowledge that I am financially responsible for and agree to pay for all services and products received at ZOOM+. I acknowledge that payment is required at the time services are rendered unless other arrangements – such as the billing of insurance - have been made. Payment for services includes payment of applicable coinsurance, copayments and deductibles for participating insurance companies. ZOOM+ accepts VISA, MasterCard, Discover Card and American Express. ZOOM+ does not accept cash.
I understand that as a courtesy to me ZOOM+ will bill health insurers with which ZOOM+ has a contract. However, I understand and agree that I (not the insurance company nor any other entity) am ultimately responsible for all fees for services rendered to me at ZOOM+, unless otherwise specified by state or federal law, or other billing arrangements have been made.
Assignment of Benefits Statement: If I have health insurance, I authorize my health insurance and health plans to make payments directly to ZOOM+. I agree to pay for any charges I owe which are not paid by insurance.
I understand that if my primary health insurance or health plan does not pay ZOOM+ within 60 days of this visit, ZOOM+ may then directly bill me or charge the total amount due on my credit card.
As a courtesy, ZOOM+ will also bill secondary insurance policies. However, if payment is not received from any secondary insurer within 30 days of billing a secondary insurer, ZOOM+ may then directly bill me or charge to my bank card the total amount billed to the secondary insurer.
Not all services provided at ZOOM+ will be covered by my health insurance. I am responsible for knowing my insurance benefits and guidelines regarding what is covered by my insurance. ZOOM+ does not know what services my particular insurance plan covers or does not cover or what the level of coverage will be. I am responsible for paying ZOOM+ for all services and products provided that are not covered by my insurance.
I understand that I am responsible for knowing whether I am eligible to use this insurance at the time of service at ZOOM+. It is my responsibility to provide ZOOM+ with valid insurance information at every visit. If my insurance is not in effect at the time of service at ZOOM+ I will pay ZOOM+ for the full amount of the bill for the services received.
Outstanding Balance and Collection Policy I agree to pay any outstanding balance within 30 days of notification.
I understand that any charges I owe to ZOOM+ that are unpaid after 60 days will be assessed a $50 collection fee and transferred to a collection agency.
I understand that any charges I owe to ZOOM+ that are unpaid after 60 days will be assessed a $50 collection fee and transferred to a collection agency. If it becomes necessary to effect collections of any amount owed on this or subsequent visits, I agree to pay for all legal costs and expenses, including reasonable attorney fees. I hereby authorize ZOOM+ to release information necessary to secure payment.
If I am a Medicare beneficiary, I understand that ZOOM+ will not be able to provide services to me, even if I prefer to pay out-of-pocket and not file a claim. This is in accordance with US federal law. Signing this financial policy is an acknowledgment that I am not a Medicare beneficiary.
I understand that I may ask a ZOOM+ employee for more information included in the separate ZOOM+ Medicare Policy Statement.
I understand that overpayments of $5.00 or less will be credited to subsequent ZOOM+ visits.
Laboratory and Radiology Services
I understand that ZOOM+ may recommend that I receive laboratory tests or radiology services at non-ZOOM+ facilities or may send laboratory samples from ZOOM+ for processing at a non-ZOOM+ facility. If ZOOM+ recommends that I obtain tests or services at another facility, I understand I am free to obtain such tests or services from any provider I choose.
I understand that I will receive a separate bill from the laboratory, imaging center, or radiology practice, depending on the service I receive.
If ZOOM+ provides me with a price of a laboratory or radiology test, it is only an estimate and other tests may be added based on laboratory testing protocols.
ZOOM+ is not responsible for the prices or payment of bills incurred for these tests
(Here is the legalese. This is the well-known “HIPAA Policy” that is now part of healthcare in America).
This privacy notice is effective as of December 7, 2011
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.
In addition, this notice describes how we use and disclose your personal information, including personal health information, that may be collected through your use of the ZOOM+ website.
At ZOOM+, we are committed to protecting the privacy rights our patients. You have a variety of rights under the federal law known as HIPAA, the Health Insurance Portability and Accountability Act of 1996, and the related Privacy Rule published by the U.S. Department of Health and Human Services. Those rights are described in this notice.
Under the HIPAA and the Privacy Rule, we have certain obligations:
We are required by law to maintain the privacy of protected health information. We must provide you with this notice of our legal duties and privacy practices with respect to your protected health information. We are required to abide by the terms of the privacy notice currently in effect. We reserve the right, when we change a privacy practice, to change the terms of our notice and to make the new notice provisions effective for all protected health information that we maintain. If we do update our policy, we will provide you with a new notice by posting a notice on our website.
What is Protected Health Information?
Health information includes more than just information about medical procedures. The term includes all information that relates to:
- The past, present, or future physical or mental health or condition of an individual.
- The provision of health care to an individual.
- The past, present, or future payment for the provision of health care to an individual.
Health information that identifies an individual or which can probably be used to identify the individual is protected by law. This protected health information is known as PHI.
Obviously, when treating you, we need to use all available relevant medical information. However, in other circumstances, we will use the minimum PHI necessary for the transaction.
When we can use health information without written authorization or reaction from you
In the following circumstances, we are permitted to use or disclosure health information without obtaining written consent (called “authorization”), or without giving you a chance to object or agree to the use of disclosure.
- For Treatment. Treatment means the provision, coordination, or management of health care and related services by one or more health care providers, including the coordination or management of health care by a health care provider with a third party; consultation between health care providers relating to a patient; or the referral of a patient for health care from one health care provider to another. For instance, if we refer you to a specialist, we will provide your relevant files to that specialist.
- For Payment. Payment means both the activities undertaken by a health care provider or health plan to obtain or provide reimbursement for the provision of health care; and by a health plan to obtain premiums or to determine or fulfill its responsibility for coverage and provision of benefits under the health plan. For instance, we will share necessary information with your insurance company to help obtain payment for your doctor visits.
- For Health Care Operations. Health care operations include (1) conducting quality assessment and improvement activities, including outcomes evaluation and development of clinical guidelines; (2) reviewing the competence or qualifications of health care professionals and plans evaluating practitioner and provider performance; or (3) certain underwriting, premium rating, and other activities relating to the creation, renewal or replacement of a contract of health insurance or health benefits. For instance, we may occasionally share your information with the supervising doctor in this clinic when we are reviewing the work of our staff.
Uses requiring your consent
We may make certain other uses and disclosures of your health information that require your consent. We will only make these uses or disclosures with your written authorization. You may revoke this authorization in writing at any time. However, the revocation does not affect actions taken before we receive it.
Other Privacy Rights You Can Exercise
You have a variety of rights under HIPAA and the Privacy Rule that you may choose to exercise. These consist of:
- The right to request restrictions on certain uses and disclosures of protected health information. For example, you can ask us to restrict use or disclosure of PHI for health care operations, restrict disclosure to persons involved in the individual’s health care, or payment for health care. You can ask us to limit disclosures made to notify family member or others about the person’s condition or location. We are not obligated to agree to these restrictions. If we do agree, we must honor that agreement (except in certain emergency situations).
- The right to receive confidential communications of protected health information. For instance, you may wish to be contacted only at home and not at work, or vice versa. For instance, if you request us to contact you only at a specific address or telephone number, we will do so or We will make every effort to accommodate reasonable requests, and have an obligation to comply if you tell us that noncompliance may endanger you.
- You can inspect and copy the protected health information we have in our files.
- You can request amendment of any inaccurate protected health information.
- On request, you can receive an accounting of the disclosures of protected health information that we have made.
- Even if you have agreed to receive privacy notices electronically, you can have, on request, a paper copy of any notice.
Personal Information Collection On The ZOOM+ Website
Personal information means any information that may be used to identify an individual, including, but not limited to, a first and last name, email address, a home, postal or other physical address, other contact information, title, birth date, gender, insurance benefit coverage, and other information when needed to provide a service you requested.
When you browse our website, you do so anonymously, unless you have previously indicated that you wish ZOOM+ to remember your login and password. We do log your IP address (the Internet address of your computer) to give us an idea of which part of our website you visit and how long you spend there. But we do not link your IP address to any personal information unless you have logged in to our website.
Like many other commercial websites, the ZOOM+ website may use a standard technology called a "cookie" to collect information about how you use the site. Please go to "Tracking Technology" below for more information.
A cookie is a small data file that certain Web sites write to your hard drive when you visit them. A cookie file can contain information such as a user ID that the site uses to track the pages you've visited, but the only personal information a cookie can contain is information you supply yourself. A cookie can't read data off your hard disk or read cookie files created by other sites.
If you prefer not to receive cookies while browsing our website, you can set your browser to warn you before accepting cookies and refuse the cookie when your browser alerts you to its presence. You can also refuse all cookies by turning them off in your browser, although you may not be able to take full advantage of ZOOM+'s website if you do so. You do not need to have cookies turned on to use/navigate through many parts of our website.
Personal Information Sharing and Disclosure
Your personal information is never shared outside ZOOM+ without your permission, except under conditions explained below. ZOOM+ may send your personal information to other companies or people under any of the following circumstances:
- When we have your consent to share the information;
- We need to share your information to provide the product or service you have requested;
- We need to send the information to companies who work on behalf of ZOOM+ to provide a product or service to you (we will only provide those companies the information they need to deliver the service, and they are prohibited from using that information for any other purpose);
- Or we want to keep you up to date on the latest product announcements, software updates, special offers or other information we think you'd like to hear about.
As a medical provider, we send you email regarding your scheduled visits and health as part of our service. In addition, we may occasionally send you information about our new products and services including free night events and other ways we’re providing radical access and control of your health. If you’d like to opt out of these latter emails you can do so by sending an email to firstname.lastname@example.org or calling 503-684-8252.
Video Visit via Skype Privacy and Security
ZOOM+ is HIPAA compliant meaning that we follow federal law for protection of your personal health information as well as other best industry practices to maintain the security of all of your personal data. Skype is an independent company that operates a secure video and data network. ZOOM+ is not responsible for the privacy, technical and security safeguards maintained by Skype for its application.
If you have a complaint about privacy matters, please let us know. You can make a complaint by writing or emailing our Privacy Officer, or filing in the “Feedback” form on our website.
You may also contact the Office for Civil Rights of the federal Department of Health and Human Services.
You will find information about the HIPAA complaint procedure on their website.
You can call toll-free for assistance at: 1-800-368-1019. We will not retaliate against you in any way for making a privacy complaint.
If you have any questions, or need further information, or wish to make a privacy complaint, please contact our Privacy Officer Paul Brown as follows:
Term of the Agreement
This Agreement will remain in full force and effect while you use the Website and/or are a Member. You may terminate your membership by contacting us at 19075 NW Tanasbourne Dr. Suite 200 | Hillsboro, OR 97124
Non-commercial Use of the Website
The Website is for the personal use of individual Members only and may not be used in connection with any commercial endeavors. Organizations, companies, and/or businesses may not become Members and should not use the Service or the Website for any purpose.
Ownership of Website Content
ZOOM+ owns and retains all proprietary rights in the Website and the Service. The Website contains the copyrighted material, trademarks, and other proprietary information of ZOOM+. Except for that information which is in the public domain or for which you have been given written permission, you may not copy, modify, publish, transmit, distribute, perform, display, or sell any such proprietary information.
Modifications to the Service
ZOOM+ reserves the right at any time to modify or discontinue, temporarily or permanently, the Service (or any part thereof) with or without notice. You agree that ZOOM+ shall not be liable to you or to any third party for any modification, suspension or discontinuance of the Service.
ZOOM+ is not responsible for any incorrect or inaccurate Content posted on the Website or in connection with the Service. ZOOM+ is not responsible for any problems or technical malfunction of any telephone network, computer online systems, servers or providers, computer equipment, software, failure of email on account of technical problems or traffic congestion on the Internet, including injury or damage to users and/or Members. Under no circumstances will ZOOM+ be responsible for any loss or damage, including personal injury or death, resulting from anyone's use of the Website or the Service, any Content posted on the Website or transmitted to Members. The Website and the Service are provided "AS-IS." ZOOM+ cannot guarantee any specific results from use of the Website and/or the Service.
Participation in Interactive Services
Members may use this Website to view certain information displayed from their medical records, including the results of certain laboratory tests. Your use of these features is considered to be a request by you to receive your lab test results online.
ZOOM+ provides you with a number of interactive online services to help you better manage your health. These services may include (but are not limited to) secure messaging relating to:
- Communicating with ZOOM+ Providers
- Appointment requests
- Accessing lab results
You agree that you will not upload or transmit any communications or content of any type (including secure messaging) that infringe upon, misappropriate, or violate any rights of any party.
In consideration of being allowed to use these Services, you agree that the following actions shall constitute a material breach of this Agreement:
- Signing on as or pretending to be another person
- Using secure messaging or transmitting any material in violation of any applicable law
- Using interactive services in a way that is intended to harm or would likely harm others
- Intentionally distributing viruses or other harmful computer code.
ZOOM+ expressly reserves the right, in its sole discretion, to terminate a user's access to any interactive services and/or to any or all other areas of the Website due to any act that would constitute a violation of this Agreement.
Links to Third Party Sites
The Service may provide, or third parties may provide, links to other World Wide Websites or resources. Because ZOOM+ has no control over such sites and resources, you acknowledge and agree that ZOOM+ is not responsible for the availability of such external sites or resources, and does not endorse and is not responsible or liable for any Content, advertising, products or other materials on or available from such sites or resources.
Use by Children
We are committed to protecting the privacy of children. You should be aware that the Website is not intended or designed to attract children under the age of 18. In addition, we require all Members to be at least 18 years old.
Jurisdiction and Choice of Law
If there is any dispute arising out of the Website and/or the Service, by using the Website, you expressly agree that any such dispute shall be governed by the laws of the State of Oregon, without regard to its conflict of law provisions, and you expressly agree and consent to the exclusive jurisdiction and venue of the state and federal courts of the Oregon for the resolution of any such dispute.
You agree to indemnify and hold ZOOM+, its subsidiaries, affiliates, officers, agents, and other partners and employees, harmless from any loss, liability, claim, or demand, including reasonable attorney's fees, made by any third party due to or arising out of your use of the Service in violation of this Agreement and/or arising from a breach of this Agreement and/or any breach of your representations and warranties set forth above.
ZOOM+ Medicare Policy
updated March 1, 2010
ZOOM+ is recognized for its fair, simple and affordable prices. However, U.S. federal law requires health care providers who provide care for Medicare beneficiaries to accept the Medicare price. Unfortunately, what Medicare pays is less than ZOOM+'s real costs of providing care. Further, U.S. federal law even prohibits Medicare beneficiaries the option of simply paying out of pocket for our services. Therefore, U.S. federal law forces ZOOM+ and many primary care physicians into the untenable position of denying health care services to Medicare beneficiaries. ZOOM+ believes that this aspect of Medicare law is nonsensical and sadly - unjust.
Therefore, ZOOM+, reluctantly and with great disappointment, cannot provide services to Medicare beneficiaries. ZOOM+ is continuing to evaluate the highly complicated and evolving federal Medicare law, and hopes to one day be able to care for Medicare beneficiaries.
If you are a Medicare beneficiary:
If you are a Medicare beneficiary, we regretfully will not be able to provide service to you, even if you prefer to pay out-of-pocket and not file a claim. This is in accordance with US federal law.
If you are Medicare-eligible but have declined Medicare coverage:
If you are Medicare-eligible but have declined Medicare coverage (for example, because you continue to be covered by your employer's policy), you will be asked at the time of your visit to verify that you are not a Medicare beneficiary. We will be honored to serve you.
ZOOM+ established at its founding the highest standard of ethical conduct in the health care industry. We created the following policies to keep your healthcare needs as our highest priority, and to provide great care at an affordable price.
ZOOM+ prohibits pharmaceutical industry representatives from meeting with ZOOM+ employees including physicians and physician assistants. ZOOM+ employees may not receive gifts from pharmaceutical industry representatives or serve as consultants to the pharmaceutical industry. ZOOM+ recognizes that the pharmaceutical industry discovers and produces therapies of vital importance to the health of the people we serve. However, ZOOM+ evaluates pharmaceutical products on the merits of the scientific evidence of a product's safety and efficacy. Pharmaceutical industry sales and marketing may distort this evaluation and consumes time devoted to caring for you.
Medical Devices and Technologies
ZOOM+ employees including physicians and physician assistants may not receive gifts from medical device and technology companies, serve as consultants to such companies or otherwise have a financial relationship with such companies.
ZOOM+ employees including physicians and physician assistants may not receive gifts from any hospital, laboratory, imaging center, emergency department or any other individual physician or provider of care to whom you may be referred. Furthermore, ZOOM+ has no financial relationship with with any hospital, laboratory, imaging center, emergency department or any individual physician or provider of care to whom you may be referred.