Patient Services Agreement

Effective Date: July 2022

Caraway, Inc. (“Caraway”), through its partnerships with professional services corporations, including Mind Body Medical Services, P.C. (d/b/a Caraway Medical Services), is honored to provide you with personalized support and care. Caraway provides management and administrative services to Caraway Medical Services; Caraway Medical Services is solely responsible for the delivery of medical and other licensed professional services (collectively, Caraway and Caraway Medical Services are referred to as “us”, “we”, “our”, or “them”).

Although this document is long, it is very important that you understand it. When you sign this document, it will represent an agreement between us. Federal and state law requires that we provide to you certain information set forth in this document. A full copy of this Patient Service Agreement and Consent Form will be furnished for your records upon request. If you have any questions, please ask your provider or our office.

  1. Membership Agreement. Our services are offered through a membership-only model. We charge a membership fee (the “Membership Fee”) for access to our services. Our Membership Fee may be modified and our current Membership Fee options are available in the Caraway mobile application (the “mobile app”). Certain members may access the services during a promotional period or through their college or other organization and may not have to pay a Membership Fee. You agreed to pay the Membership Fee at the intervals indicated when you signed up for the membership with Caraway. You also authorized Caraway or its third-party contractor to charge the credit card you provided to Caraway at the intervals you agreed to when you signed-up for the membership; unless you terminate this Agreement prior to the date on which Caraway would charge your card for the Membership Fee. You understand that Caraway will automatically charge your credit card at such intervals. The Membership Fee covers cost associated with the services that enhance your experience, such as higher-touch services related to prescription refills, referral management, and scheduling support. These enhanced services are not typically covered by insurance or other health care benefits such as a Health Savings Account or a Flexible Spending Account. As a result, you acknowledge that you may not be able to submit and obtain payment for the Membership Fee from your insurance or other benefit plan.
  2. Telehealth. You agree to receive telehealth services in the specialty for which you scheduled your services (the “Telehealth Services”). Telehealth involves the use of audio, video, or other electronic communications to interact with you, consult with your health care provider, and/or review your medical information for the purpose of diagnosis, therapy, follow-up, and/or education; telehealth may be provided as synchronous (in real time) or asynchronous (not in real time, such as by sending a chat or a photo and later receiving a response). During your telehealth consultation with Caraway Medical Services providers, details of your medical history and personal health information may be disclosed and/or discussed with other health professionals through the use of interactive video, audio, and telecommunications technology. The benefits of telehealth include having access to specialists and additional medical information and education without having to travel outside of your home or local health care community. A potential risk of telehealth is that because of your specific medical condition or due to technical problems, a face-to-face consultation may still be necessary after the telehealth appointment. Additionally, in rare circumstances, security protocols could fail, causing a breach of patient privacy. The alternative to receiving Telehealth Services is a face-to-face visit with a Caraway or independent provider. You understand the risks, benefits, and alternatives of receiving Telehealth Services. You may ask your provider any questions you may have regarding Telehealth Services. You may be requested to sign additional consents or provide additional information before receiving Telehealth Services if you reside in a state where additional documentation or additional information is required prior to receiving Telehealth Services.

    Telehealth Services should not be used for a medical or mental health emergency; in a medical or mental health emergency you should dial 911, or if you are feeling suicidal, you should call or chat with the 988 for the Suicide & Crisis Lifeline.
  3. Mental Health Services Delivered Via Telehealth.

    If you agree to receive Mental Health Services from Caraway Medical Services, you acknowledge that there is a potential risk that you may experience uncomfortable feelings such as sadness, guilt, anxiety, anger, frustration, loneliness, and helplessness because the process of receiving Mental Health Services often requires discussing the unpleasant aspects of your life, and approaching feelings or thoughts you have tried not to think about for a long time that may be painful. Making changes in your beliefs or behaviors can be scary and sometimes disruptive to your established relationships. The benefits of Mental Health Services may include a significant reduction in feelings of distress, increased satisfaction in interpersonal relationships, greater personal awareness and insight, increased skills for managing stress, and resolutions to specific problems. However, there are no guarantees about the results of Mental Health Services.

    If, for any number of unforeseen reasons, you do not hear from your provider, or your provider is unable to reach you, and you feel you cannot wait for a return call or if you feel unable to keep yourself safe, take the following steps:

  4. Call 911 and explain your emergency, and/or
  5. Call an emergency crisis hotline, such as 988 for the Suicide & Crisis Lifeline, and/or
  6. Go to your local Hospital Emergency Room, and/or
  7. Consult the resources your school provides for how to contact the emergency resources they offer.

  8. You may be requested to sign additional consents or notices or provide additional information before receiving Mental Health Services if you reside in a state where additional documentation or additional information is required prior to receiving such services. If you reside in California, your acknowledgment below affirms that you have read the relevant notice to California consumers regarding the electronic delivery of mental health services, issued by the California Department of Consumer Affairs, Board of Psychology, which may be found here, and that you consent to receive Mental Health Services after reviewing the notice.
  9. Team-Based/Integrated Approach to Care. Caraway Medical Services believes that the best care is provided when all members of your healthcare team work together in an integrated system of care. Accordingly, and in furtherance of this model, all professionals involved in your care, including primary care providers and mental health providers may share information regarding your care and treatment in order to provide you with the best care possible for you, except when sharing this information is expressly prohibited by law.
  10. Scheduling Services. All services can be scheduled by using our mobile app.
  11. Payment Methods. You understand and agree the Membership Fee shall be due at the intervals or dates you elect to make payment when you signed up for services. Your payment for Telehealth Services and any other service you receive from Caraway Medical Services shall be made prior to or at the time of service, except for the portion of the payment that may be covered by your insurance plan. If you will be using insurance to cover some or all of the cost of your appointment, you should contact us ahead of your appointment to ensure that your insurance is accepted and provide a photo of your insurance card prior to the appointment via our mobile app. You should be prepared to pay any co-payments at the time of the appointment. If we are out-of-network for your insurance, we will submit an out-of-network claim on your behalf and bill you only for the copayment, coinsurance, or amount not covered. We accept payment in the form of a credit card, which you expressly authorize for us to charge for the Telehealth Services and any other service you elect to receive from Caraway Medical Services that is not covered by your insurance.
  12. Consent for Assignment of Insurance Benefits. You authorize the payment of insurance benefits payable directly to us, and you assign and transfer to us all right, title, and interest in the right to receive all benefits payable for the health care rendered that are provided for in any and all insurance policies and/or plans that will be applied to the amount charged for services rendered by your Caraway Medical Services provider(s).
  13. Cancellation Policy. For any appointment that is scheduled in advance, excluding on-demand chat-based care interactions, you understand that your appointment must be canceled no less than one [1] hour in advance or you will be responsible for full payment for the missed visit, unless your insurance prohibits us from billing you for missed visits.
  14. Confidentiality and Compliance. We will take appropriate precautions to keep your health information confidential. You are also protected under the provisions of the federal Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) and any other applicable federal and state laws related to the protection of patient information and how we will use and disclose your protected health information. Our Notice of Privacy Practices (“NPP”) discusses how we will use and disclose your protected health information; you have received a copy of our NPP, as it is available here. The most up-to-date NPP is posted on our website. We will not disclose your health information without your consent except as set forth in the NPP.

    As set forth in the NPP, there are some situations in which we are legally obligated to take action and disclose your health information to protect yourself or others from harm. For example, if we become aware of child, elderly or other types of abuse or if a patient is threatening serious bodily harm to another, we may be required in certain states to disclose health information to state authorities or others.

  15. Consent to Call, Email, Text, and Application Messaging. You expressly consent to allow our agents and us to communicate with you by telephone call, email, text message, messaging via the mobile app, and/or other forms of unencrypted electronic messaging (“Electronic Messages”) using any telephone numbers or email addresses that you provide us or that we obtain lawfully, such as through caller ID. You expressly agree to receive prerecorded or automated Electronic Messages from us. You agree to receive these Electronic Messages from us even if your phone number is listed on the National Do Not Call Registry. You agree that you are the current owner of any telephone number you provide us. Wireless or data charges from your carrier may apply, and we are not responsible for these charges.

    You understand that we do not require that you give your consent to receive automated Electronic Messages in order to receive services from us.

    You understand that Electronic Messages sent by us may include, without limitation, appointment reminders, changes in previously scheduled appointments, actions to take in advance of appointments, follow-ups from appointments, information regarding insurance and billing, marketing material, or advice or education.

    You understand the risks associated with communicating through Electronic Messages, including, without limitation, that Electronic Messages can easily be mis-addressed to or forwarded to unintended recipients, that Electronic Messages can be stored, that backup copies of Electronic Messages may exist even after the Electronic Messages are deleted, that Electronic Messages may not be secure and thus may be used or forwarded without your permission or knowledge, that Electronic Messages may be inspected by your telephone carrier, and that Electronic Messages may be used as evidence in court.

    You understand that we are not liable for any breaches of confidentiality caused by you or a third party.

    You agree that in a medical emergency, you should not use Electronic Messages. Instead, you should call 911.

    You understand that Electronic Messages may be filed in your medical record.

    You may opt out of automated Electronic Messages, including in-app messages or notifications, SMS, and/or email, at any time. Your notification options and preferences are available in the Caraway mobile app. You may also send your request via in-app message to the Caraway team or via email to support@caraway.health. You acknowledge and agree to receive a final message confirming your choice to opt out. Unless you revoke your consent to communicate with us via Electronic Messages, your consent will last through the end of your relationship with us.

    You acknowledge that telephone calls to or from us may be monitored and recorded. You agree to this monitoring and recording.

    In exchange for the services provided by us, you release Caraway and Caraway Medical Services from all claims, causes of action, lawsuits, damages, losses, liabilities, or other harms relating to any Electronic Messages you exchange with them. You release Caraway and Caraway Medical Services from all claims, causes of action, or lawsuits based on any alleged violations of any laws, including the Telephone Consumer Protection Act, the Truth in Caller ID Act, the CAN-SPAM Act, the Fair Debt Collection Practices Act, the Fair Credit Reporting Act, HIPAA, any similar state and local acts or statutes, and any federal or state tort or consumer protection laws.
  16. Acknowledgments.
  17. You have read and understand the information provided above and understand and agree to the terms in this agreement, including the services, payment methods, and cancellation policy. Any questions you had have been answered.
  18. You also understand that, under HIPAA, you have certain rights to privacy regarding your health information. You have received, read, and understand Caraway Medical Services’ NPP containing a complete description of the uses and disclosures of your health information. You understand that Caraway Medical Services has the right to change its NPP from time to time and that you may contact Caraway Medical Services at any time to obtain a current copy of the NPP.
  19. Updates/Revisions. We may update this Patient Services and Consent Form upon thirty (30) days’ notice to you. Notice and updates will be provided via the mobile app and will be available at https://www.caraway.health/patient-services-agreement.