Terms and Conditions
1. Acceptance of Terms
By accessing or using the Prevail Healthcare website (prevailhealthcare.org) and any services offered by Prevail Healthcare, including but not limited to our Patient Advocate Program, Community Health Integration (CHI) services, Annual Wellness Visits, and related care coordination services (collectively, the "Services"), you agree to be bound by these Terms and Conditions. If you do not agree, do not use our website or Services.
2. About Prevail Healthcare
Prevail Healthcare is a Medicare-enrolled provider organization offering patient advocacy and care coordination services to Medicare beneficiaries. We are not affiliated with any government agency, the Centers for Medicare & Medicaid Services (CMS), or the Social Security Administration. Our services are provided under Medicare Part B and Medicare Advantage benefits.
3. Eligibility for Services
Our Services are available to individuals who:
- Are enrolled in Medicare Part A and Part B, or in a Medicare Advantage plan
- Meet medical necessity requirements as determined by a qualified healthcare practitioner
- Reside in a state where Prevail Healthcare is authorized to operate
- Are at least 18 years of age (or have a legal guardian's consent)
Eligibility for specific services, including Community Health Integration (CHI), requires a qualifying initiating visit with a Prevail Healthcare clinician and identification of medical and social factors that affect your ability to manage your health. We do not guarantee eligibility or coverage for any specific service.
4. Description of Services
Prevail Healthcare's Services may include:
- Annual Wellness Visits (AWV) conducted via telehealth or in-person
- Evaluation and Management (E/M) office visits
- Community Health Integration (CHI) services billed under CMS codes G0019 and G0022
- Patient advocacy and care coordination assistance with Medicare benefits, durable medical equipment (DME) procurement, prescription support, transportation coordination, and navigation of insurance benefits
- Referrals to other healthcare providers when appropriate
All clinical services are provided by licensed Nurse Practitioners, Physicians, or other qualified healthcare professionals operating within their scope of practice and applicable state licensure.
5. Not Medical Advice
Information provided on this website is for general informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of information you obtained from our website.
6. Patient Consent and Cost-Sharing
By enrolling in Prevail Healthcare Services, you acknowledge:
- You have been informed about the nature of the Services being provided
- You consent to receive Services from Prevail Healthcare
- You understand that cost-sharing (deductibles, copayments, coinsurance) may apply based on your Medicare plan
- You have been informed that only one practitioner can bill for certain care coordination services (such as CHI, CCM, or PCM) per calendar month
- You may discontinue Services at any time by notifying Prevail Healthcare in writing or by phone
- You retain the right to choose your own healthcare providers and equipment suppliers
7. Telehealth Consent
When you receive Services via telehealth, you acknowledge:
- Telehealth involves the use of electronic communications to enable healthcare providers at different locations to share patient information
- The same standards of care apply to telehealth as to in-person care
- Technical failures may occur during a telehealth visit, in which case the visit may be rescheduled
- You have the right to refuse telehealth and request an in-person visit where available
8. Insurance and Billing
Prevail Healthcare bills Medicare and Medicare Advantage plans directly for covered Services. You are responsible for any cost-sharing amounts (deductibles, copayments, coinsurance) as determined by your plan. If a claim is denied, you may be responsible for payment of the Services received.
We do not guarantee that Medicare or your Medicare Advantage plan will cover any specific service. Coverage determinations are made by your insurance plan, not by Prevail Healthcare.
9. Use of the Website
You agree to use our website only for lawful purposes. You may not:
- Use the website in any way that could disable, overburden, damage, or impair the site
- Attempt to gain unauthorized access to any portion of the website or any systems or networks connected to the website
- Use any robot, spider, or other automatic device to access the website for any purpose
- Submit false, misleading, or inaccurate information through our website
- Use the website to transmit any viruses, malware, or harmful code
- Impersonate any person or entity or misrepresent your affiliation with any person or entity
10. Intellectual Property
All content on the website, including text, graphics, logos, images, and software, is the property of Prevail Healthcare or its licensors and is protected by United States and international copyright, trademark, and other intellectual property laws. You may not reproduce, distribute, modify, or create derivative works of any content without express written permission.
11. User-Submitted Information
When you submit information through our website (including via online forms, intake submissions, or eligibility verification), you represent that:
- All information provided is true, accurate, and complete
- You have the legal right to provide such information
- You consent to the use of such information for the purposes described in our Privacy Policy
We reserve the right to verify any information you submit and to refuse Services to any individual who provides false or misleading information.
12. Disclaimers
The Services and the website are provided on an "as is" and "as available" basis. To the fullest extent permitted by law, Prevail Healthcare disclaims all warranties, express or implied, including but not limited to implied warranties of merchantability, fitness for a particular purpose, and non-infringement.
Prevail Healthcare does not warrant that:
- The website will be uninterrupted, secure, or error-free
- The results obtained from the use of the Services will be accurate or reliable
- Any errors in the website or Services will be corrected
13. Limitation of Liability
To the fullest extent permitted by law, Prevail Healthcare, its officers, directors, employees, contractors, and agents shall not be liable for any indirect, incidental, special, consequential, or punitive damages arising out of or relating to your use of the website or Services, even if Prevail Healthcare has been advised of the possibility of such damages.
In no event shall Prevail Healthcare's total liability to you for all damages exceed the amount paid by you to Prevail Healthcare in the twelve (12) months preceding the event giving rise to liability.
This limitation does not apply to claims for medical malpractice, which shall be governed by applicable state law.
14. Indemnification
You agree to indemnify, defend, and hold harmless Prevail Healthcare and its officers, directors, employees, contractors, and agents from and against any and all claims, liabilities, damages, losses, costs, and expenses (including reasonable attorneys' fees) arising out of or relating to:
- Your use of the website or Services
- Your violation of these Terms
- Your violation of any rights of another person or entity
- Information you submit through the website that proves to be false or misleading
15. Governing Law and Dispute Resolution
These Terms shall be governed by and construed in accordance with the laws of the State of Illinois, without regard to its conflict of law provisions. Any disputes arising out of or relating to these Terms or the Services shall be resolved through binding arbitration administered by the American Arbitration Association under its Commercial Arbitration Rules, except that either party may seek injunctive relief in a court of competent jurisdiction in Cook County, Illinois.
You waive any right to participate in a class action or class-wide arbitration. Any arbitration shall be conducted on an individual basis.
16. HIPAA and Privacy
Prevail Healthcare is a HIPAA-covered entity. Our handling of Protected Health Information (PHI) is described in our Notice of Privacy Practices, available upon request and provided to all patients at the time of service. Our website privacy practices are described in our Privacy Policy.
17. Communications
By providing your phone number, email address, or other contact information, you consent to receive communications from Prevail Healthcare via phone calls, text messages (SMS), email, and mail. You may opt out of marketing communications at any time, but cannot opt out of communications necessary for the provision of Services (such as appointment reminders, clinical follow-up, or billing notices).
18. Mobile Messaging (SMS Carrier Compliance)
By providing your mobile phone number and opting in to receive SMS messages from Prevail Healthcare, you are agreeing to receive text messages from us related to your healthcare services, including appointment scheduling, appointment reminders, eligibility verification, care coordination, follow-up communications, and billing notifications.
Opt-Out: Text STOP to opt-out of SMS communications at any time. After replying STOP, you will receive a confirmation message and no further messages will be sent.
Help: Text HELP for customer support. You can also contact us at (888) 341-6223 or support@prevailhealthcare.org.
Message and Data Rates: Message and data rates may apply. Message frequency varies based on your interaction with our Services. Prevail Healthcare is not responsible for charges from your wireless carrier.
Carrier Disclaimer: Carriers are not liable for delayed or undelivered messages.
For complete SMS terms, see our SMS Terms and Conditions at https://prevailhealthcare.org/sms-terms.
19. Third-Party Links
Our website may contain links to third-party websites. Prevail Healthcare is not responsible for the content, privacy practices, or terms of use of any third-party websites. Use of third-party websites is at your own risk.
20. Modifications to Terms
We reserve the right to modify these Terms at any time. Changes will be effective upon posting to the website. Your continued use of the website or Services after changes are posted constitutes your acceptance of the modified Terms. We encourage you to review these Terms periodically.
21. Severability
If any provision of these Terms is found to be unenforceable, the remaining provisions shall continue in full force and effect.
22. Entire Agreement
These Terms, together with our Privacy Policy and SMS Terms and Conditions, constitute the entire agreement between you and Prevail Healthcare regarding your use of the website and Services.
23. Contact Information
Prevail Healthcare
Phone: (888) 341-6223
Email: support@prevailhealthcare.org
Website: prevailhealthcare.org