DISCLAIMER

I understand, and agree, that any procedures, medical care, and/or services provided by Express Health Systems and/or any of its Affiliates, including but not limited to any of its Telemedicine Services (eVisits) and Associated Clinics, (hereafter collectively referred to as EHS), will not be submitted by EHS to my medical insurance provider, Medicare, Medicaid, Supplemental Medical Insurance, and/or any other healthcare coverage I may have (hereafter referred to collectively as “my insurance medical coverage”) for reimbursement purposes by EHS. I understand that EHS is not a provider for my insurance medical coverage. I waive any of my insurance medical coverage rights that may be afforded me in consideration for any procedures, medical care, and/or services provided by EHS. I am aware, and acknowledge, that procedures, medical care, and/or services provided by EHS may or may not be covered by my medical insurance coverage; and I furthermore acknowledge that any rights granted to me by any and all coverage provided by any of these are voluntarily made null-in-void/waived by me regarding any procedures, medical care, and/or services provided by EHS at any of its physical EHS clinics and/or via any of its Telemedicine Systems. I understand, and agree, that any disputes that may arise regarding any of these issues, are null-in-void in favor of EHS. By choosing to be a patient with EHS I waive my rights to have any care provided by them to be submitted by them to my medical insurance coverage company/companies. I fully accept the charges at the rate/rates assigned by EHS. I accept, and understand, that the rates set by EHS may be different than the rates set by any of the entities that comprise my medical insurance coverage. I explicitly understand the statements herein, and agree that I have voluntarily waived any blanket rights provided by any of my medical insurance coverage that pertains to any procedures, medical care, and or services provided to me by EHS. I understand, and agree, that any providers/clinicians of EHS that perform any procedures on/me and/or provide me any other medical care and/or services at EHS are not independently obligated and/or responsible for following any rights otherwise afforded me by any of the entities that make up my medical insurance coverage. This statement is true regardless of whether or not EHS’s provider/clinician that provided care for me at EHS is or is not listed as a provider for any of the entities that make up my medical insurance coverage. This statement regarding the provider/clinician is also true regardless of whether that provider/clinician provides services for any practice/facility outside of/separate from EHS and regardless of whether or not that other facility is a provider for any entity within my medical insurance coverage group. I understand, and agree, that any procedure/s, medical care, and/or service/s performed and/or provided by EHS is waived from the provider’s duties and obligations set forth by my medical insurance coverage regardless of the EHS clinic/location/service, duration, cost, or type of procedure/s/medical care/and/or service/s. I understand, and agree, that any court, state board, medical insurance, City/County,State &/or Federal Government, Medicare, Medicaid, Supplemental Coverage, and/or any other health care provider proceedings taken against EHS, and/or its clinicians, staff, owners and the like, are null-in-void in favor of EHS regarding reimbursement from and/or any rights/obligations/fees structures and/or other specifics described in the document regarding this and it’s affiliated subjects. I understand, and agree, that I am waiving my healthcare coverage rights afforded me by any of the entities within my medical insurance coverage in favor of paying fees set forth by EHS for any and all procedures, medical care, and/or services provided to me by EHS.

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