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Health Plan*

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Consent*

I agree to the privacy policy.

I consent and authorize the hospital, any physician or other caregiver, as well as any of their related entities, agents, or contractors, including but not limited to schedulers, debt collectors, and other contracted staff (any or all of these is referred to as “Provider”) to use automated telephone dialing systems, text messaging systems and electronic mail to (1) provide messages (including pre-recorded messages or text messages) to me about my account, payment due dates, missed payments, information for or related to medical goods and/or services provided, exchange information, changes to the health care law, health care coverage, care follow-up, and other healthcare information or (2) provide telemarketing messages (including pre-recorded messages) during a call or via text message that delivers a “health care” message made by, or on behalf of, a “covered entity” or its “business associate,” as those terms are defined in the HIPAA Privacy Rule, 45 CFR 160.103.

Telephone messages may be played by a machine automatically when the telephone is answered, whether answered by me or someone else. These messages may also be recorded by my answering machine. I give the Provider permission to call or send a text message to any telephone number I give the Provider and to play pre-recorded messages or send text messages with information about my transactions over the phone, and understand that such information may not be encrypted or secure.

I promise that, unless I indicate otherwise, I own or customarily use the telephone numbers I give the Provider. I also promise to notify the Provider in writing within 30 days if I change phone number(s). I understand that Provider will continue to use the number I provide unless I provide notice of a change, and, therefore, failure to notify Provider may result in missed or delayed communications.
I also give the Provider permission to communicate such information to me via electronic mail, and understand that such information may not be encrypted or secure.

I agree that the Provider will not be liable to me for any calls or electronic communications, even if information is communicated to an unintended recipient (including, for example, contacts to a previous number that I have not notified the Provider is no longer used by me).

I understand that, when I receive such calls or electronic communications, I may incur a charge from the company that provides me with telecommunications, wireless and/or Internet services. I agree that the Provider has no liability for such charges.

I understand that consent to receive calls/messages is not a condition of receiving medical services. I also understand that I may revoke my consent to contact at any time by directly contacting Provider or utilizing the opt–out method that will be identified in the applicable communication.

Need to find a primary care doctor, a specialist, or an urgent care/hospital? Our “Find a Doc” tool lets you quickly search our network of more than 6,000 providers in 1,800 locations. Convenient, affordable, high-quality care is just a few clicks away.

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Need to find a primary care doctor, a specialist, or an urgent care/hospital? Our “Find a Doc” tool lets you quickly search our network of more than 6,000 providers in 1,800 locations. Convenient, affordable, high-quality care is just a few clicks away.

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