Terms and Agreement
Monthly premiums are due every month on the same day as enrollment (e.g., if Client enrolls on the 5th
day of the first month, the monthly payment is due on the 5th
day of each subsequent month).
As used in the above Plans:
sessions are initiated by Client’s request communicated to SynrgyMed by logging into Dashboard. Client must have an initial face-to-face visit with a Provider before medications can be called in to the pharmacy. Provider will respond to request by Client within two hours of receipt of the request. Client must be able to download the Cisco “app” known as “Webex”. Client is responsible for paying all text and data fees charged by a third party such as client’s cell phone provider. In the discretion of the Provider, email and text communications between Client and a Provider and/or SynrgyMed may be made a part of the Client’s permanent medical record. Client is hereby cautioned that email or text is not the appropriate means of communication regarding emergency or other time-sensitive issues or for inquiries regarding sensitive information, and such communications are best made by calling SynrgyMed at (877)682-0043.
The following medications will not be prescribed by Providers: Norco, Vicodin, Tylenol with Codeine, Oxycodone, Oxycontin, Fentanyl, Morphine Sulfate, Soma, Flexeril, Robaxin, Adderall, Viagra, Cialis, Phentermine, Phenergan with Codeine.
Client is responsible to ascertain the cost of and to pay for all medications and prescriptions.
Personalized Lifestyle Improvement Plan.
Following a comprehensive examination by a Provider, Client will receive a folder with a lifestyle improvement plan and goals discussed and established during the examination for improvement to Client’s lifestyle. Provider will review and if appropriate discuss the lifestyle improvement plan once a month with Client to assist Client in working toward the set goals.
All house calls are by appointment only and will be set by mutual agreement of the Client and Provider. Each house call will be limited to one hour of Services rendered by the Provider. Because a Provider may have to travel some distance and forgo seeing other patients, Client must cancel a house call request at least 24 hours in advanced of the date and time set for the house call or Client will be charged $50 (to be billed to Client’s credit card on file with SynrgyMed). House calls shall not involve any OB/GYN Services.
Clients may request additional house calls, laboratory analyses, or other Services, which shall be agreed to mutually between Client and SynrgyMed and shall be confirmed in a writing setting forth the Services to be provided and the cost for each Service to be provided in advance of the provision of any such Service(s).
SynrgyMed will assist the Client in scheduling appointments, downloading required apps, utilizing apps, and telehealth setup. SynrgyMed staff will also facilitate care coordination with Client’s primary care physicians, specialists, skilled nursing facilities, and hospitals and other facilities.
SynrgyMed will maintain a website and app through which each Client can access secure emails and information, schedule visits, and view account balance.
In the event of an emergency or urgent situation and Client does not receive a response from a Provider within the specified time, Client will call SynrgyMed or seek emergency treatment at a nearby facility.
IF YOU ARE EXPERIENCING AN EMERGENCY, CALL 9-1-1 IMMEDIATELY
Termination and Cancellation
SynrgyMed shall not be obligated to provide Services and this Agreement shall be terminated as follows:
- Client fails to pay the required monthly premium after the Client has been duly notified and billed for the charge. The Plan and this Agreement shall terminate thirty (30) days after Client has been duly notified of the cancellation and billed for the charge.
- Client has engaged in fraud or an intentional misrepresentation of Material fact under the terms of this Agreement, in which case this Agreement shall terminate immediately.
- Client no longer resides, lives, or works in the Plan's Service Area, in which case this Agreement shall terminate immediately.
- SynrgyMed ceases to provide or arrange for the provision of health benefits for new health care service plan contracts in the individual or group market, or all markets, in California and SynrgyMed has notified Client at least 180 days prior to discontinuation of the Plan in which Client has enrolled, in which case this Agreement shall terminate 180 days after such notice.
- SynrgyMed withdraws a health benefit plan from the market and notifies Client all health benefit plans that it makes available to new individual Enrollees, in which case this Agreement shall terminate 180 days after such notice.
Client may have an opportunity for review of certain cancellations by the Director as provided in Section 1365(b) of the Act.
The Plan is subject to the requirements of Chapter 2.2 of Division 2 of the Code and of Chapter 1 of Title 28 of the California Code of Regulations, and any provision required to be in this Agreement by the same or the Act shall bind the SynrgyMed whether or not provided in this Agreement.
Upon termination of a Provider contract, SynrgyMed shall be liable for covered services rendered by such Provider (other than for co-payments as defined in subdivision (g) of Section 1345 of the Act) to Client who retains eligibility under this Agreement or by operation of law under the care of such Provider at the time of such termination until the Services being rendered to Client by such Provider are completed, unless SynrgyMed makes reasonable and medically appropriate provision for the assumption of such Services by a contracting Provider. In the event SynrgyMed fails to pay a noncontracting provider, Client may be liable to the noncontracting provider for the cost of services.
In the event of cancellation by either SynrgyMed (except in the case of fraud or deception in the use of Services or facilities of the Plan or knowingly permitting such fraud or deception by another) or the Client, SynrgyMed shall within 30 days return to Client the pro rata portion of the money paid to SynrgyMed which corresponds to any unexpired period for which payment had been received together with amounts due on claims, if any, less any amounts due the Plan.
Receipt by SynrgyMed of the proper prepaid or periodic payment after cancellation of the Plan and this Agreement for nonpayment shall reinstate the Plan as though it had never been cancelled if such payment is received on or before the due date of the succeeding prepaid or periodic payment.
Changes to Plans
SynrgyMed has procedures for any written or oral complaint or other expression of dissatisfaction regarding the Plan and/or Provider, including quality of care concerns, made within 180 days following any incident or action that is the subject of the Client’s dissatisfaction.
The first step for Client is to contact SynrgyMed’s Customer Service Department at (877) 682-0043. If the Customer Service Department is unable to resolve Client’s complaint or dissatisfaction, Client may submit a written grievance by obtaining a grievance form by mail through the Customer Service department or by downloading the grievance form on SynrgyMed’s website (www. Synrgymed.com) and mailing it to the address listed on the same website. Upon request by Client, SynrgyMed will provide assistance to Client if he or she has limited English proficiency, has a visual or other communicative impairment, needs an interpreter, or needs telephone relay systems and other devices that aid disabled individuals to communicate.
SynrgyMed’s Medical Director shall render a written response to Client within 30 days of receipt of Client’s written or oral complaint or other expression of dissatisfaction.
If Client is dissatisfied with the Medical Director’s response, Client may request reconsideration by SynrgyMed’s Board of Directors. SynrgyMed’s Board of Directors shall render a decision on Client’s grievance within 30 days of receipt of Client’s request for reconsideration.
If Client is dissatisfied with SynrgyMed’s Board of Directors’ response, Client may file a complaint or grievance with the Director.