Terms and Conditions

The provisions of the Authorization for Release of Medical Records and Information describe how you are authorizing MBH to use, share and obtain information regarding the patient’s medical treatment. The Customer Agreement describes the terms under which MBH will negotiate medical bills on behalf of the patient. ________________________________________ AUTHORIZATION FOR RELEASE OF MEDICAL RECORDS AND INFORMATION: This document authorizes the use and/or disclosure of confidential protected health information about me, my family member or another person for whom I am the duly authorized agent (each of the persons referred to above are hereafter called the “Patient”). I hereby authorize MEDICAL BILL HELPER, INC. (“MBH”) and its employees and business associates to disclose and utilize all of the Patient’s personal, financial and health information that has been provided to MBH, whether through the MBH website or otherwise (the “Provided Information”). I hereby authorize MBH to use and disclose the Provided Information to the Patient’s health care providers and/or insurance companies solely for the purpose of negotiating medical bills with such entities on behalf of the Patient. I authorize MBH to transmit the Provided Information by electronic means, e-mail or by fax. I agree to hold MBH harmless from any claims that might arise from transmitting, using or disclosing the Provided Information. I hereby appoint MBH as the Patient’s authorized personal representative to obtain any of the Patient’s personal, financial and health information (“Patient Information”) from the Patient’s health care providers and/or insurance companies as MBH deems necessary or helpful in connection with MBH negotiating medical bills on behalf of the Patient. I hereby authorize the Patient’s health care providers and/or insurance companies to release and transfer to MBH all Patient Information MBH may request for the purpose of negotiating the Patient’s medical bill. This Authorization includes Patient Information pertaining to the specific procedures referenced on the bill from the Patient’s health care provider or Explanation of Benefits from the Patient’s insurance company, and also includes Patient Information pertaining to HIV Related Illness, AIDs, Drugs and/or Alcohol Treatment, Mental Illness and/or Developmental Disability Treatment. In the event that the Patient’s health care provider and/or insurance company requests confirmation from MBH concerning this Authorization, I hereby authorize MBH to provide such confirmation and take such action as the health care provider and/or insurance company may reasonably request, including signing and sending a copy of this authorization to the Patient’s health care provider and/or insurance company on behalf of the Patient. I understand that this Authorization may be revoked by me in writing or by e-mail at any time upon notice to Medical Bill Helper (support@medicalbillhelper.com). I understand that my revocation will be effective immediately except to the extent that any actions have been taken in reliance thereon prior to my sending notice of revocation. This Authorization is valid for the period of time necessary for MBH to conduct a review of the Patient’s medical charges and for MBH to attempt to negotiate a settlement with the Patient’s health care provider and/or insurance company. ________________________________________ CUSTOMER AGREEMENT: This Agreement pertains to me, my family member or another person for whom I am the duly authorized agent (each of the persons referred to above are hereafter called the “Patient”). I hereby authorize MEDICAL BILL HELPER, INC. (“MBH”) and its employees and agents to act as the Patient’s authorized personal representative for the purpose of obtaining a reduction in the Patient’s medical bill liability. I represent that I have provided accurate information to MBH regarding (a) the Patient’s health care provider and/or insurance company, (b) the medical treatment received by the Patient, and (c) my Credit or Debit Card. I agree that I will use reasonable efforts to cause the Patient’s health care provider and/or insurance company (as necessary) to provide to MBH all of the information requested by MBH and described in the Authorization. MBH agrees that it will use reasonable efforts on the Patient’s behalf to attempt to cause the Patient’s health care provider and/or insurance company to reduce the medical charges (which must exceed $300) for which the Patient has asked MBH to attempt to negotiate a reduction. I hereby authorize MBH to provide Credit or Debit Card information and related information I have entered on the MBH site to charge my Credit or Debit Card, as a fee for MGH’s services rendered, an amount equal to thirty-five (35%) percent of the amount saved by the negotiated reduction. (For example, if the amount saved by MBH is $200, MGH’s fee would be $70, paid by the Patient through MBH’s charging my Credit or Debit Card.) Corporate clients will pay a 30% fee. I hereby agree that sufficient funds are available to pay MGH’s fee, I authorize MBH to charge my Credit or Debit Card company for the negotiation fee if the discount received is greater than10%. If sufficient funds are not available to pay the Patient’s health care provider, I understand and agree that it will be my obligation to pay the Patient’s health care provider and my Credit or Debit Card company as normal practice, and that MBH, by agreeing and attempting to negotiate a settlement on my behalf, has not in any way agreed to accept responsibility or liability for paying the Patient’s health care provider, my insurance company, my Credit or Debit Card company or any other person. I agree that once an agreement has been made with the Patient’s health care provider, MBH shall be entitled to its fee, that the fee paid to MBH shall be final, and that I will not be entitled to a refund for any reason. In the event that MBH is not able to obtain a reduction of at least 10% in cost from the Patient’s health care provider, I understand that I will not be charged a fee or otherwise have any obligation to MBH. Release: I hereby agree to release MBH, its directors, officers and employees, from any and all claims I may have, or may ever have, arising out of the performance of MBH of the services contemplated by the Agreement. This Release also includes, without limitation, any claims for violation of my rights of privacy under applicable laws and unintentional disclosure of information, and it includes any claims that I may have relating to MBH’s use, or the Patient’s health care provider’s use, of my Credit or Debit Card and the Credit or Debit Card information related to such cards. The provisions of this Release shall survive and continue after the termination of the Agreement. Indemnity: I hereby agree that I will indemnify and hold harmless MBH and its directors, officers and employees against any and all claims made or causes of action asserted against any of them by me or any other persons (including the Patient’s health care provider) arising out of MBH’s (1) use of the information provided to it as set forth in the Authorization for Release of Medical Records and Information and this Customer Agreement, (2) use of my Credit or Debit Card as set forth in the Agreement, and (3) arising out of or relating to the work and other matters authorized by me pursuant to the Agreement. The provisions of this Indemnity shall survive and continue after the termination of the Agreement. I understand that, except for the Release and Indemnity, this Agreement shall terminate when I give to MBH written notice of termination, except that my obligations under this Agreement which became effective before I gave notice of termination shall continue. If not previously terminated, the Agreement will terminate when either the work and payments have been completed or MBH has advised me that it has not been able to negotiate a reduction. By creating your user name and clicking the Create Account button, you are indicating your agreement with our terms. If you do not agree, you should not submit a medical bill for negotiation. If you wish to retract a submitted bill, you may contact us via email at support@medicalbillhelper.com.