LunaJoy Health, Inc.

TELEHEALTH INFORMED CONSENT

These terms and conditions of use govern your use of our online interfaces and properties (e.g., websites and mobile applications) owned and controlled by LunaJoy Health, Inc., including the hellolunajoy.com website (the “Site”) and any information delivered on this Site or via Email communication as the services (“Services”) and products (“Products”) available to users through the Site. LunaJoy Health, Inc. (“LunaJoy”, “we,” “us,” and “our”) contracts with Thriving Lane LLC for online telehealth medical treatments/consultations and secure messaging between Thriving Lane LLC clinicians/therapists/nurses/care managers/coaches/care coordinators/care navigators/prescribers/doctors/physician assistants (individually the “Provider” and collectively the “Providers”) and their patients. The professional medical services (which are provided by Thriving Lane LLC and its affiliates) and the non-clinical Site services (which are provided by Lunajoy and its affiliates) are collectively referred to in this Terms of Use as the “Services”. The terms “you” and “your” means you, your dependent(s) if any, and any other person involved in your treatment by Lunajoy and it’s affiliates.

Terms of Use

Acceptance of Terms of Use

Welcome to LunaJoy. These Terms of Use (the "Terms") are a binding contract between you ("you" or "user") and LunaJoy, Inc. ("LunaJoy," "we", or "us"). You must agree to and accept all of the Terms, or you do not have the right to use the Services. Your using the Services in any way means that you agree to all of these Terms, and these Terms will remain in effect while you use the Services. These Terms include the provisions in this document, as well as those in our privacy policy (www.hellolunajoy.com/privacy).

NOTICE: Please read these Terms carefully. They cover important information about Services provided to you and any charges, taxes, and fees we bill you. These Terms include information about future changes to these Terms, automatic renewals, limitations of liability, a class action waiver, and resolution of disputes by arbitration instead of in court. You can review the most current version of the Terms of Service at hellolunajoy.com. We reserve the right to update, change or replace any part of these Terms of Use by posting updates and/or changes to our website. It is your responsibility to check this page periodically for changes. Your continued use of or access to the website following the posting of any changes constitutes acceptance of those changes.

General

We reserve the right to refuse service to anyone for any reason at any time. You understand that your content (not including credit card information), may be transferred unencrypted and involve (a) transmissions over various networks; and (b) changes to conform and adapt to technical requirements of connecting networks or devices. Credit card information is always encrypted during transfer over networks. You agree not to reproduce, duplicate, copy, sell, resell or exploit any portion of the Service, use of the Service, or access to the Service or any contact on the website through which the service is provided, without express written permission by us. The headings used in this agreement are included for convenience only and will not limit or otherwise affect these Terms.

We use the Device Information that we collect to help us screen for potential risk and fraud (in particular, your IP address), and more generally to improve and optimize our Site (for example, by generating analytics about how our customers browse and interact with the Site, and to assess the success of our marketing and advertising campaigns).

Personal Information

Your submission of personal information is governed by our Privacy Policy.

Accuracy, Completeness, and Timeliness of Information

We are not responsible if information made available on this site is not accurate, complete or current. The material on this site is provided for general information only and should not be relied upon or used as the sole basis for making decisions without consulting primary, more accurate, more complete or more timely sources of information. Any reliance on the material on this site is at your own risk.This site may contain certain historical information. We reserve the right to modify the contents of this site at any time, but we have no obligation to update any information on our site. You agree that it is your responsibility to monitor changes to our site. ‍

Modifications to Services and Prices

Prices for our products are subject to change without notice. We reserve the right at any time to modify or discontinue the Service (or any part or content thereof) without notice at any time. We shall not be liable to you or to any third-party for any modification, price change, suspension or discontinuance of the Services.

Third-Party Payment Processor

You agree to pay us, through our payment processor or financing partner (as applicable), all charges at the prices then in effect for any purchase in accordance with the applicable payment terms presented to you at the time of purchase. You agree to make payment using the payment method you provide when you set up your account. We reserve the right to correct, or to instruct our payment processor or financing partner to correct, any errors or mistakes, even if payment has already been requested or received

Bill Inquiries and Refunds

If you believe you have been billed in error, please notify us within 30 days of the billing date by emailing care@hellolunajoy.com. LunaJoy and its affiliates will not issue refunds or credits after the expiration of this 30-day period, except where required by applicable law.

Consent to Receive Calls and Text Messages. By providing your mobile number, sending LunaJoy an initial text, or otherwise opting-in to receive telephonic communications from LunaJoy, you are agreeing to be contacted by LunaJoy, on behalf of the LunaJoy Health Inc or Thriving Lane LLC, at the mobile number you have provided, including calls, text, and push notification messages, regarding your User Account and use of the Platform and Services. These communications may be automated and may include information about your treatment plan, appointment reminders, order confirmations, shipping notifications, messages from your Provider, and other transactional messages. You may also separately sign up to receive promotional and marketing Communications. You are not required to consent to promotional and marketing communications as a condition of purchase. You may update your notification preferences at any time by emailing care@hellolunajoy.com. By consenting to receive text messages from us, you represent that you are the subscriber of the cellular service at the mobile number provided or that you are authorized by the subscriber to sign-up for texts.

If you enroll in text messages with us, you understand and agree that: (1) you will be responsible for any message and data rates that may apply for any messages sent to you from LunaJoy Health Inc, (2) message frequency may vary, and (3) LunaJoy Health Inc, nor are Cerebral Medical Groups’ mobile carriers, liable for delayed or undelivered messages. If you have any questions about your text plan or data plan, it is best to contact your wireless provider.

Our text messages are supported on all U.S. carriers. Please note, however, that the supporting mobile carriers may change without notice, and the particular text message program you join may be limited to specific carriers.

You can opt out of marketing text messages from LunaJoy by emailing care@hellolunajoy.com. Please be advised that if you opt out of marketing text messages, LunaJoy may still send you transactional text messages.

Sensitive Communications. You understand that while LunaJoy Health Inc and Thriving Lane LLC take your privacy and the security of your health and other sensitive information very seriously, the transmission of information over the internet and mobile networks is not 100% secure. Text messages and emails that you send to or receive from LunaJoy Health Inc are not encrypted, which means that it is possible they may be intercepted by third parties. If you choose to send or receive information about your health or any other sensitive information by text message or email outside, you do so at your own risk. By opting into text messages, you consent to sending text messages to LunaJoy Health Inc, and receiving text messages from or on behalf of LunaJoy Health Inc, that are not encrypted. Likewise, by emailing LunaJoy Health Inc or giving LunaJoy Health Inc your email, you consent to receiving unencrypted emails messages from or on behalf of LunaJoy Health Inc and Thriving Lane LLC.

Indemnification

You agree to indemnify, defend and hold harmless LunaJoy and our parent, subsidiaries, affiliates, partners, officers, directors, agents, contractors, licensors, service providers, subcontractors, suppliers, interns and employees, harmless from any claim or demand, including reasonable attorneys’ fees, made by any third-party due to or arising out of your breach of these Terms of Service or the documents they incorporate by reference, or your violation of any law or the rights of a third-party. ‍

Binding Arbitration. These Terms of Use provide that all disputes between you and Lunajoy Health, Inc and its affiliates. That in any way relate to these Terms of Use or your use of the Site will be resolved by BINDING ARBITRATION. ACCORDINGLY, YOU AGREE TO GIVE UP YOUR RIGHT TO GO TO COURT (INCLUDING IN A CLASS ACTION PROCEEDING) to assert or defend your rights under these Terms of Use. Your rights will be determined by a NEUTRAL ARBITRATOR and NOT a judge or jury and your claims cannot be brought as a class action. Please review the Section below entitled Dispute Resolution; Arbitration Agreement for the details regarding your agreement to arbitrate any disputes with Lunajoy

Entire Agreement

The failure of us to exercise or enforce any right or provision of these Terms of Service shall not constitute a waiver of such right or provision.These Terms of Service and any policies or operating rules posted by us on this site or in respect to The Service constitutes the entire agreement and understanding between you and us and govern your use of the Service, superseding any prior or contemporaneous agreements, communications and proposals, whether oral or written, between you and us (including, but not limited to, any prior versions of the Terms of Service). Any ambiguities in the interpretation of these Terms of Service shall not be construed against the drafting party.

HEALTH INSURANCE PORTABILITY ACCOUNTABILITY ACT (HIPAA)

This document contains important information about federal law, the Health Insurance Portability and Accountability Act (HIPAA), that provides privacy protections and patient rights with regard to the use and disclosure of your Protected Health Information (PHI) used for the purpose of treatment, payment, and health care operations.

HIPAA requires that we provide you with a Notice of Privacy Practices (the Notice) for use and disclosure of PHI for treatment, payment and health care operations. The Notice explains HIPAA and its application to your PHI in greater detail. You acknowledge that we have provided you with this. If you have any questions, it is your right and obligation to ask so we can have a further discussion prior to signing this document. When you sign this document, it will also represent an agreement between us. You may revoke this Agreement in writing at any time. That revocation will be binding unless we have taken action in reliance on it.

LIMITS ON CONFIDENTIALITY

The law protects the privacy of all communication between a patient and a healthcare provider. In most situations, we can only release information about your treatment to others if you sign a written authorization form that meets certain legal requirements imposed by HIPAA. There are some situations where we are permitted or required to disclose information without either your consent or authorization.

If such a situation arises, we will limit our disclosure to what is necessary. Reasons we may have to release your information without authorization:

If you are involved in a court proceeding and a request is made for information concerning your diagnosis and treatment, such information is protected by the psychologist-patient privilege law. We cannot provide any information without your (or your legal representative's) written authorization, or a court order, or if we receive a subpoena of which you have been properly notified and you have failed to inform me that you oppose the subpoena. If you are involved in or contemplating litigation, you should consult with an attorney to determine whether a court would be likely to order me to disclose information.
IIf a government agency is requesting the information for health oversight activities, within its appropriate legal authority, we may be required to provide it for them.
If a patient files a complaint or lawsuit against us, we may disclose relevant information regarding that patient in order to defend ourselves.
If a patient files a worker's compensation claim, and we are providing necessary treatment related to that claim, we must, upon appropriate request, submit treatment reports to the appropriate parties, including the patient's employer, the insurance carrier or an authorized qualified rehabilitation provider.

We may disclose the minimum necessary health information to our business associates that perform functions on our behalf or provide us with services if the information is necessary for such functions or services. Our business associates sign agreements to protect the privacy of your information and are not allowed to use or disclose any information other than as specified in our contract. There are some situations in which we are legally obligated to take actions, which we believe are necessary to attempt to protect others from harm, and we may have to reveal some information about a patient's treatment:

If we know, or have reason to suspect, that a child under 18 has been abused, abandoned, or neglected by a parent, legal custodian, caregiver, or any other person responsible for the child's welfare, the law requires that we file a report with the state and/or state specific organizations. Once such a report is filed, we may be required to provide additional information.
If we know or have reasonable cause to suspect that a vulnerable adult has been abused, neglected, or exploited, the law requires that we file a report with the state and/or state specific organizations. Once such a report is filed, I may be required to provide additional information.
If we believe that there is a clear and immediate probability of physical harm to the patient, to other individuals, or to society, we may be required to disclose information to take protective action, including communicating the information to the potential victim, and/or appropriate family member, and/or the police or to seek hospitalization of the patient.
Your treatment team may share information about your assessment and treatment in an anonymized way with the clinical team at LunaJoy Health Inc in order to improve your experience and guarantee that we are providing you with the most effective care possible. You may let us know that you do not want your information shared in this way by speaking with your treatment team.

CLIENT RIGHTS AND CLINICIANS DUTIES

Use and Disclosure of Protected Health Information:

For Treatment – We use and disclose your health information between our LunaJoy providers for coordination of care purposes. Your records also may be released to other healthcare providers that are involved in your medical care as a way to ensure collaboration and coordination of care for you between both treatment teams. These records might involve sharing mental health and medical information, test results, treatment plans, and other relevant details. Aside from these circumstances, if we wish to provide information outside of our practice for your treatment by another health care provider, we will have you sign an authorization for release of information. A release of information is required for most uses and disclosures of psychotherapy notes. By acknowledging the above, you give us consent to import and review medication provided by SureScripts.
For Payment – We may use and disclose your health information to obtain payment for services provided to you as delineated in the Therapy Agreement.
For Operations – We may use and disclose your health information as part of our internal operations. For example, this could mean a review of records to assure quality. We may also use your information to tell you about services, educational activities, and programs that we feel might be of interest to you.

Patient's Rights:

Right to Treatment – You have the right to ethical treatment without discrimination regarding race, ethnicity, gender identity, sexual orientation, religion, disability status, age, or any other protected category.
Right to Confidentiality – You have the right to have your health care information protected. If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will agree to such unless a law requires us to share that information.
Right to Request Restrictions – You have the right to request restrictions on certain uses and disclosures of protected health information about you. However, we are not required to agree to a restriction you request.
Right to Receive Confidential Communications by Alternative Means and at Alternative Locations – You have the right to request and receive confidential communications of PHI by alternative means and at alternative locations.
Right to Inspect and Copy – You have the right to inspect or obtain a copy (or both) of PHI. Records must be requested in writing and release of information must be completed. Furthermore, there is a copying fee charge of $1.00 per page. Please make your request well in advance and allow 2 weeks to receive the copies. If we refuse your request for access to your records, you have a right of review, which we will discuss with you upon request.
Right to Amend – If you believe the information in your records is incorrect and/or missing important information, you can ask us to make certain changes, also known as amending, to your health information. You have to make this request in writing. You must tell us the reasons you want to make these changes, and we will decide if it is and if I refuse to do so, we will tell you why within 60 days.
Right to a Copy of This Notice – If you received the paperwork electronically, you have a copy in your email. If you completed this paperwork at your first session a copy will be provided to you per your request or at any time. Right to an Accounting – You generally have the right to receive an accounting of disclosures of PHI regarding you. On your request, I will discuss with you the details of the accounting process.
Right to an Accounting – You generally have the right to receive an accounting of disclosures of PHI regarding you. On your request, I will discuss with you the details of the accounting process.
Right to Choose Someone to Act for You – If someone is your legal guardian, that person can exercise your rights and make choices about your health information; we will make sure the person has this authority and can act for you before we take any action.
Right to Choose – You have the right to decide not to receive services with LunaJoy and its providers. If you wish, we will provide you with names of other qualified professionals.
Right to Terminate – You have the right to terminate therapeutic services with us at any time without any legal or financial obligations other than those already accrued. We ask that you discuss your decision with your clinician in session before terminating or at least contact LunaJoy by phone letting us know you are terminating services.
Right to Release Information with Written Consent – With your written consent, any part of your record can be released to any person or agency you designate. Together, we will discuss whether or not we think releasing the information in question to that person or agency might be harmful to you.

Clinician's Duties: We are required by law to maintain the privacy of PHI and to provide you with a notice of our legal duties and privacy practices with respect to PHI. We reserve the right to change the privacy policies and practices described in this notice. Unless we notify you of such changes, however, we are required to abide by the terms currently in effect. If we revise our policies and procedures, we can provide you with a revised notice over electronic communication or mail.

Your signature below indicates that you have read this agreement and agree to its terms and also serves as an acknowledgment that you have received the HIPAA notice form described above.

I understand practice policies, HIPAA and consent. I have discussed any questions that I have regarding this information with Thriving Lane LLC/ LunaJoy Health Inc. My signature below indicates that I am voluntarily giving my informed consent to receive coaching, therapy, and/or medication management services and agree to abide by the agreement and policies listed in this consent. I authorize Thriving Lane LLC/ LunaJoy Health Inc and/or its providers to provide therapy and/or medication management services that are considered necessary and advisable.

I authorize the release of treatment and diagnosis information necessary to process bills for services to my insurance company, and request payment of benefits to Thriving Lane LLC/ LunaJoy Health Inc. I acknowledge that I am financially responsible for payment whether or not covered by insurance. I understand, in the event that fees are not covered by insurance, Thriving Lane LLC/ LunaJoy Health Inc may utilize payment recovery procedures after reasonable notice to me, including a collection company or collection attorney.

Consent to Treatment of Minor Child(ren): I hereby certify that I have the legal right to seek mental health treatment for minor(s) in my custody and give permission to Thriving Lane LLC/ LunaJoy Health Inc and its providers to provide treatment to my minor child(ren). If I have unilateral decision-making capacity to obtain mental health services for my minor, I will provide the appropriate court documentation to Thriving Lane LLC/ LunaJoy Health Inc prior to or at the initial session. Otherwise, I will have the other legal parent/guardian sign this consent for treatment prior to the initial session.

Consent to Telehealth: Telehealth is typically an electronic transmission of data, using video calling, using technologies provided by the electronic health record, for improved patient access and convenience, which can result in a better patient care experience. Telehealth does have some considerations:

The inability to have direct, physical contact with the patient is a primary difference between telehealth and direct in-person service delivery. I agree that the clinician determines whether or not the condition being diagnosed and/or treated is appropriate for a telemedicine encounter.
The knowledge, experiences, and qualifications of the EHR providing data and information to the provider of the telehealth services need not be completely known to and understood by the practice. AdvancedMD does take active and layered security measures with the use of telemedicine technologies.
In addition, the quality of transmitted data may affect the quality of services provided by the provider. The patient agrees to hold the clinician and Thriving Lane LLC/ LunaJoy Health Inc harmless for information lost due to technical failures.
Your clinician will record all video sessions for ongoing quality improvement, quality assurance, training, and development of our services. The video recordings may be retained for up to 12 months and then deleted. If you do not agree to have your sessions recorded, please let your clinician know at your first appointment and the beginning of subsequent appointments. We may retain some information from the session in a fully de-identified and anonymized format for longer than the prespecified period for ongoing quality assurance, training, and development of our services and technology.
Your provider may use live listening tools and other technology services during or after your session that utilize the video recordings, audio recording or transcripts from your sessions or asynchronous communications with your provider or LunaJoy staff in conjunction with Artificial Intelligence technologies to enhance the quality of care they provide to you as well as to assist the provider and LunaJoy Health Inc with administrative tasks such as but not limited to visit documentation and coding for visits.

The practice may, in some cases, be required to forward patient-identifiable information to a third party, for instance upon request by your insurance company. This is not different than the requirements for other non-telehealth medical records.

Consent to Share Information with Your Other Healthcare Providers

By signing this consent, you agree that we can communicate with other healthcare providers involved in your care. Your records may be released to other healthcare providers (SUCH AS BUT NOT LIMITED TO PCPs, OBGYN, ETC), without a separate release of information, that are involved in your care as a way to ensure collaboration and coordination of care for you between both treatment teams. These records may involve but not limited to sharing mental health and medical information, test results, treatment plans, and other relevant details. We also may request medical records from your healthcare providers and HIEs, including but not limited to prescription drug monitoring programs (PDMP), pharmacy, and healthcare systems that you may be receiving care from.

Research, Writing, Teaching: Your physician and others at LCA conduct internal research to improve our services, training, and supervision. Your physician may use information about you and your treatment in any of these ways. Your physician or others at LCA may also prepare publications for professional and/or lay audiences, and any use of information about your treatment would be only in an anonymized and/or de-identified way for these publications.

Group Sessions:

Sharing information in groups can help yourself and others and is voluntary. You may choose to share as much or as little as you feel comfortable with. Do not share group information outside of the group setting.
You agree to not disclose any information to people outside of the group that may reasonably be used to identify another member of the group. You agree to not record any voice conversations, videos, and/or create still images of any information shared in the group by the use of any recording device, application, or otherwise. You agree to join the group in a private location and take measures such as wearing a headset to prevent those outside of the group from seeing or hearing the group.
LunaJoy Health Inc and its contracted partners reserve the right to make disclosures of any information gathered in the group in a manner which is consistent with our Notice of Privacy Practices and Privacy Policy and/or as otherwise required by applicable state and federal laws.
You agree to hold harmless LunaJoy Health Inc/Thriving Lane LLC, and its contracted partners, in any and all claims related to misuse and/or misappropriation of your personal and/or protected health information, shared during group sessions, by another group member or persons who obtain your information through another group member.
Your Group facilitator may share additional parameters from time to time. To the extent you have questions about these or any other Group parameters, or would like to receive a copy in writing, you should reach out to your care team. If you continue to attend Group sessions, we will assume that you have agreed and consented to the additional parameters.

MEDICAL NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

This Notice of Privacy Practices (the “Notice”) describes how your information is used. Specifically, how Thriving Lane LLC, and each of the medical groups to which it provides certain support services, (collectively “LunaJoy Medical Group,” “we,” “our,” or “us”) may use and disclose your protected health information to carry out treatment, payment, or business operations and for other legally permissible purposes. For a complete list of the member groups, please send an email to compliance@hellolunajoy.com

“Protected health information” or “PHI” is information about you, including demographic information, that may identify you and that relates to your past, present, or future physical or mental health or condition, treatment, or payment for health care services. This Notice also describes your rights to access and control your protected health information.

USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION:

Your protected health information may be used and disclosed by our health care providers, our staff, and others outside of our office who are involved in your care and treatment for the purpose of providing health care services to you, to support our business operations, to obtain payment for your care, and any other use authorized or required by law.

TREATMENT:

We will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of your health care with a third party. For example, your protected health information may be provided to a health care provider to whom you have been referred to ensure the necessary information is accessible to diagnose or treat you.

PAYMENT:

Your protected health information may be used to bill or obtain payment for your health care services. This may include certain activities that your health insurance plan may undertake before it approves or pays for your services, such as: making a determination of eligibility or coverage for insurance benefits and reviewing services provided to you for medical necessity.

HEALTH CARE OPERATIONS:

We may use or disclose, as needed, your protected health information in order to support our business activities. These activities include, but are not limited to, improving quality of care, providing information about treatment alternatives or other health-related benefits and services, development or maintaining and supporting computer systems, legal services, and conducting audits and compliance programs, including fraud, waste and abuse investigations.

USES AND DISCLOSURES THAT DO NOT REQUIRE YOUR AUTHORIZATION:

To comply with applicable law, we may use or disclose your protected health information in the following situations without the need to obtain your authorization. These situations include the following uses and disclosures: as required by law; for public health activities; for health care oversight activities; pursuant to Food and Drug Administration requirements; for abuse, neglect, or domestic violence reporting; for judicial and administrative proceedings; for law enforcement purposes; to coroners and medical examiners, funeral directors and organ donation agencies; for certain research purposes; to avert serious threat to health or safety; for specialized government functions; for certain criminal activities; for workers’ compensation reporting; relating to certain inmate reporting; and other required uses and disclosures. Under the law, we must make certain disclosures to you upon your request, and when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the requirements of the Health Insurance Portability and Accountability Act (“HIPAA”). State laws may further restrict these disclosures.

USES AND DISCLOSURES THAT REQUIRE YOUR AUTHORIZATION:

Other permitted and required uses and disclosures will be made only with your consent, authorization, or opportunity to object unless permitted or required by law. Without your authorization, we are expressly prohibited from using or disclosing your protected health information for marketing purposes. We may not sell your protected health information without your authorization. Your protected health information will not be used for fundraising. We will not use or disclose your psychotherapy notes without your authorization, except as permitted by law. If you provide us with an authorization for certain uses and disclosures of your information, you may revoke such authorization, at any time, in writing, except to the extent that we have taken an action in reliance on the use or disclosure indicated in the authorization.

YOUR RIGHTS WITH RESPECT TO YOUR PROTECTED HEALTH INFORMATION:

You have the right to inspect and copy your protected health information.
You may request access to or an amendment of your protected health information. Responses to these requests will be timely provided.
You have the right to request a restriction on the use or disclosure of your protected health/personal information. Your request must be in writing and state the specific restriction requested and to whom you want the restriction to apply. We are not required to agree to a restriction that you may request, except if the requested restriction is on a disclosure to a health plan for a payment or health care operations purpose regarding a service that has been paid in full out-of-pocket.
You have the right to request to receive confidential communications from us by alternative means or at an alternate location. We will comply with all reasonable requests submitted in writing which specify how or where you wish to receive these communications.
You have the right to request an amendment of your protected health information. If we deny your request for amendment, you have the right to file a statement of disagreement with us. We may prepare a rebuttal to our statement and we will provide you with a copy of any such rebuttal.
You have the right to receive an accounting of certain disclosures of your protected health information that we have made, paper or electronic, except for certain disclosures which were pursuant to an authorization, for purposes of treatment, payment, healthcare operations or for certain other purposes.
You have the right to obtain a paper copy of this Notice, upon request, even if you have previously requested its receipt electronically by e-mail

REVISIONS TO THIS NOTICE:

We reserve the right to revise this Notice and to make the revised Notice effective for protected health information we already have about you as well as any information we receive in the future. You are entitled to a copy of the Notice currently in effect. Any significant changes to this Notice will be posted on our web site. You then have the right to object or withdraw as provided in this Notice. The date this Policy was last revised is identified at the top of the page on our website where this policy is located. You are responsible for periodically monitoring and reviewing any updates to the. Your continued use of our Services after such amendments will be deemed your acknowledgment of and agreement to these changes to these changes.

BREACH OF HEALTH INFORMATION:

We will notify you if a reportable breach of your unsecured protected health information is discovered. Notification will be made to you no later than 60 days from the breach discovery and will include a brief description of how the breach occurred, the protected health information involved and contact information for you to ask questions.

COMPLAINTS:

Complaints about this Notice or how we handle your protected health information should be directed to our HIPAA Privacy Officer (compliance@hellolunajoy.com). If you are not satisfied with the manner in which a complaint is handled you may submit a formal complaint to the Department of Health and Human Services, Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/. We will not retaliate against you for filing a complaint

We must follow the duties and privacy practices described in this Notice. We will maintain the privacy of your protected health information and to notify affected individuals following a breach of unsecured protected health information. If you have any questions about this Notice, please email us at compliance@hellolunajoy.com or call us at (727) 291-9538 and ask to speak with our HIPAA Privacy Officer.

This notice fulfills the requirements laid out in 45 CFR 164.520(b).

BILLING AUTHORIZATION

All professional services rendered are charged to the patient and are due at the time of service.

I hereby assign all medical and mental health benefits, to include major medical benefits to which I am entitled. I hereby authorize and direct my insurance carrier(s), including Medicare, private insurance and any other mental health/medical plan, to issue payment check(s) directly to Thriving Lane LLC/ LunaJoy Health Inc for coaching/therapy/medication management services rendered to myself and/or my dependents regardless of my insurance benefits, if any.

I am aware that there may be a coinsurance or deductible balance after my claim processes with my insurance carrier. These amounts are based on my individual plan with the insurance carrier. I authorize LunaJoy to charge the card on file for any outstanding insurance balance at that time.

I understand that I am responsible for any amount not covered by insurance.

Missed Appointments and Cancellations:Failure to provide sufficient notice for cancellations and/or repeated no-shows for your appointment may impact your ability to schedule additional appointments. If you cancel or reschedule within 48 business hours of a scheduled session, or you do not attend a scheduled session, you may be charged a $100.00 Late Cancellation Payment. We reserve the right to change these fees at any time. It is our policy to post any changes we make to our fees on our website. You are responsible for periodically monitoring and reviewing any updates to our fee schedule. Your continued use of our Services after such amendments will be deemed your acknowledgment of and your agreement to changes in our fee schedule.

I authorize Thriving Lane LLC/ LunaJoy Health Inc to release information necessary to insurance carriers regarding my therapy and sessions. I understand that my clinician may be required to release certain information to the insurance company at their request in order to procure necessary authorizations and or process claims for payment. This information may include, but is not limited to types of service, dates of service, times of service, diagnosis, treatment plans, progress of therapy/medication management and at times, treatment notes and/or summaries. I authorize the release of such information if necessary, understanding the limits of confidentiality regarding the use of my insurance benefits.

I also acknowledge receipt of Lunajoy's Notice of Privacy Practices.

I have requested therapy/medication management/coaching services from Thriving Lane LLC/ LunaJoy Health Inc on behalf of myself and/or my dependents, and understand that by making this request, I become fully financially responsible for any and all charges incurred in the course of the treatment authorized.

I understand and agree with the above notices, and consent to using telehealth at Thriving Lane LLC/ LunaJoy Health Inc. Thriving Lane LLC/LunaJoy Health Inc reserves the right to update, change or replace any part of this policy by posting updates and/or changes to our website. I understand it is my responsibility to check this page periodically for changes. My continued use of or access to the website or services following the posting of any changes constitutes acceptance of those changes.

DISPUTE RESOLUTION; ARBITRATION AGREEMENT

We will try to work in good faith to resolve any issue you have with Site, including Products and Services procured through the Site, if you bring that issue to the attention of our customer service department. However, we realize that there may be rare cases where we may not be able to resolve an issue to a customer’s satisfaction.

You and Lunajoy agree that any dispute, claim or controversy arising out of or relating in any way to these Terms of Use or your use of the Site, including Products and Services procured through the Site, shall be determined by binding arbitration instead of in courts of general jurisdiction. Arbitration is more informal than bringing a lawsuit in court. Arbitration uses a neutral arbitrator instead of a judge or jury, and is subject to very limited review by courts. Arbitration allows for more limited discovery than in court, however, we agree to cooperate with each other to agree to reasonable discovery in light of the issues involved and amount of the claim. Arbitrators can award the same damages and relief that a court can award, but in so doing, the arbitrator shall apply substantive law regarding damages as if the matter had been brought in court, including without limitation, the law on punitive damages as applied by the United States Supreme Court. You agree that, by agreeing to these terms and conditions, the U.S. Federal Arbitration Act governs the interpretation and enforcement of this provision, and that you and Lunajoy are each waiving the right to a trial by jury or to participate in a class action. This arbitration provision shall survive termination of these terms and conditions and any other contractual relationship between you and Lunajoy.

YOU AND COMPANY AGREE THAT EACH MAY BRING CLAIMS AGAINST THE OTHER ONLY IN YOUR OR ITS INDIVIDUAL CAPACITY, AND NOT AS A PLAINTIFF OR CLASS MEMBER IN ANY PURPORTED CLASS OR REPRESENTATIVE PROCEEDING. Further, unless both you and Lunajoy agree otherwise, the arbitrator may not consolidate more than one person’s claims with your claims, and may not otherwise preside over any form of a representative or class proceeding. The arbitrator may award declaratory or injunctive relief only in favor of the individual party seeking relief and only to the extent necessary to provide relief warranted by that party’s individual claim.

If this Agreement to Arbitrate provision is found to be unenforceable, then (a) the entirety of this arbitration provision shall be null and void, but the remaining provisions of these Terms of Use shall remain in full force and effect; and (b) exclusive jurisdiction and venue for any claims will be in state or federal courts located in and for the State of Delaware, USA.

DISCHARGE POLICY

If a patient has 2 consecutive no-shows, the Front Desk will attempt 2 outreach calls (on different days) and 2 texts (on different days). After the 2nd consecutive no-show, there will be a 30-day period open to re-engage the patient and help get them booked.
If the patient re-engages after the 2nd consecutive no-show and requests an appointment, and then no-shows their 3rd consecutive appointment, the patient will be discharged.
If a patient has 2 consecutive no-shows, has not responded to either calls/texts to re-engage, and the 30-day re-engagement window closes, patient will be discharged.
If you do not keep your scheduled appointments and do not respond to communications from your care team, we will assume you have elected to end your treatment and we will close your case. If this occurs, and you wish to resume your treatment, please contact our care team to reinitiate care.

ACKNOWLEDGEMENTS

I ACKNOWLEDGE that any request to Lunajoy is not an emergency or urgent matter.

If you are or believe you are experiencing a medical or psychiatric emergency, including suicidal or homicidal thinking, side effects to medication, or any other urgent or time-sensitive matter in which you need an immediate response, DO NOT use this service. You can access emergency assistance by calling the National Suicide Prevention Lifeline at 1-800-273-8255 or by calling 911.

I UNDERSTAND that due to federal regulations, Lunajoy Health, Inc d/b/a Thriving Lane, LLC is unable to prescribe controlled substances (Adderall, Ritalin, Xanax, Klonopin, etc).

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