Below is our Direct Primary Care (DPC) membership agreement for your review. You’ll be asked to confirm your agreement to these terms when you complete enrollment.

RIVERCROSS HEALTH

1. Nature of the Agreement – Direct Primary Care, Not Insurance

1.1 Direct Primary Care Model. This Agreement is for ongoing, routine primary care services delivered directly by the Practice to the Member in exchange for a recurring membership fee.

1.2 Not Health Insurance.
The Member understands and agrees that:

  • This Agreement is not a health insurance policy or health plan.

  • The membership fee is not a health insurance premium.

  • This Agreement does not provide comprehensive health coverage and does not cover hospital services, specialist care, emergency room care, surgery, or services provided by other facilities or clinicians not employed by the Practice.

  • This Agreement does not satisfy any requirement for “minimum essential coverage” under the Affordable Care Act or any similar federal or state law.

1.3 Separate Coverage Recommended. The Member is strongly advised to maintain separate health insurance and/or a health sharing plan to cover hospitalizations, specialty care, emergency services, and other high-cost or out-of-scope services. The Practice does not guarantee that any health insurance or health sharing plan will reimburse or “share” membership fees or any services.

2. Services Covered by Membership

Subject to the terms of this Agreement, the membership includes access to primary care services customarily provided in a family medicine practice, including but not limited to:

  • Office visits for acute and chronic medical conditions

  • Preventive and wellness visits (e.g., annual exams, school/sport physicals)

  • Chronic disease management (e.g., hypertension, diabetes, asthma, etc.)

  • Basic in-office procedures as listed in the Practice’s current service list

  • Telemedicine/virtual visits when clinically appropriate

  • Direct text/phone/secure messaging with the physician during posted hours

  • Coordination of care with specialists, hospitals, and other providers

  • Evaluation and management of hormonal balance for both men and women (e.g., low testosterone, thyroid disorders, perimenopause/menopause and related concerns), including history, examination, appropriate laboratory testing, and treatment or referral when indicated

The Practice may update the list of specific services included in membership from time to time, with reasonable notice to Members.

3. Services Not Covered

The following are not included in the membership fee and may require separate payment or insurance/health sharing coverage:

  • Hospitalizations, emergency room visits, urgent care center visits

  • Specialist consultations and procedures

  • Surgery or interventional procedures

  • Advanced imaging (e.g., CT, MRI, nuclear studies)

  • Services provided by other facilities or clinicians not employed by the Practice

  • Durable medical equipment and supplies

  • Most vaccinations (unless specifically listed as included)

  • Any service for which the Practice informs the Member in advance that additional fees apply

The Practice will make reasonable efforts to assist Members in arranging discounted cash pricing for labs, imaging, and medications when available, but such third-party costs are the Member’s responsibility.

4. Membership Fees and Payment

4.1 Membership Fee.
The Member agrees to pay the Practice a recurring membership fee in the amount set forth in the Practice’s then-current fee schedule (e.g., individual, couple, child, family tier pricing). Fees may vary by age, household type, or other factors as published by the Practice.

4.2 Billing and Payment Method.
Membership fees are billed in advance on a monthly basis (or other agreed frequency) via credit card, debit card, or ACH withdrawal. The Member authorizes the Practice or its billing agent to charge the designated account for membership fees as they come due.

4.3 Fee Changes.
The Practice may adjust membership fees in the future. Any change will apply prospectively and will be communicated to the Member in writing (including by email or patient portal) at least 30 days before the new fee takes effect.

4.4 Nonpayment.
If payment is not received within the grace period specified in the Practice’s policies (e.g., 15 days), the Practice may suspend services and/or terminate this Agreement. The Member remains responsible for any unpaid amounts accrued prior to termination.

4.5 Refunds.
Unless otherwise required by law, membership fees are not prorated or refunded for partial months, except in the case of Practice-initiated termination without cause, in which case any prepaid, unused portion of membership fees will be refunded.

5. Term and Termination

5.1 Term.
This Agreement is effective as of the Effective Date and continues on a month-to-month basis unless terminated by either party.

5.2 Termination by Member.
The Member may terminate this Agreement at any time by providing written notice (including email or patient portal message). Termination is effective at the end of the current billing period unless otherwise agreed.

5.3 Termination by Practice.
The Practice may terminate this Agreement for any of the following reasons, with written notice:

  • Nonpayment of membership fees

  • Repeated failure to adhere to Practice policies

  • Abusive, threatening, or inappropriate behavior toward staff or other patients

  • Clinical circumstances in which the Member’s needs exceed the Practice’s scope of care

  • Other reasons permitted by applicable law and professional ethics

Except in cases of serious misconduct or safety concerns, the Practice will generally provide at least 30 days’ notice and offer reasonable assistance in transferring care to another provider.

5.4 Effect of Termination.
Upon termination, the Member is no longer entitled to membership benefits or services under this Agreement. The Practice will provide copies or transfers of medical records as required by law.

6. Insurance, Medicare/Medicaid, and Health-Sharing Plans

6.1 No Insurance Billing.
The Practice does not bill or submit claims to commercial insurance, Medicare, Medicaid, or other government programs for services covered under this Agreement. The Member agrees not to request the Practice to do so.

6.2 No Assignment of Benefits.
Membership fees are paid directly by the Member and are not assigned to any insurer or third party. The Practice does not guarantee that any insurer or health-sharing plan will reimburse or credit membership fees or other charges.

6.3 Medicare/Medicaid Beneficiaries.
At this time, the Practice does not enroll patients who are active beneficiaries of Medicare or Medicaid for services covered under this Agreement. If the Member becomes eligible for or enrolls in Medicare or Medicaid during the term of this Agreement, the Member must notify the Practice promptly, and this Agreement may be terminated or revised in accordance with applicable law.

6.4 Health-Sharing and Reimbursement.
Some Members may choose to pair this membership with a separate health sharing plan or ministry. The Member is solely responsible for confirming with any such plan whether membership fees, labs, imaging, or medications are eligible for sharing or reimbursement. The Practice does not represent or warrant that any portion of fees or services will be reimbursed.

6.5 Tax-Advantaged Accounts.
Whether membership fees may be paid from or reimbursed by an HSA, FSA, or similar account depends on current tax law and the Member’s specific plan. The Practice does not provide tax advice, and the Member should consult their tax advisor.

7. Communication, Telemedicine, and Access

7.1 Non-Emergency Use Only.
The Member may contact the Practice via phone, text, email, or secure messaging for non-emergency medical concerns during posted hours. For any medical emergency, the Member agrees to call 911 or go to the nearest emergency department and not rely on text, email, or voicemail.

7.2 Telemedicine.
The Practice may provide evaluation and treatment via video, phone, or electronic messaging when clinically appropriate and permitted by law. The Member understands the limitations and risks of telemedicine and agrees that telemedicine encounters are treated as visits under this Agreement.

7.3 Response Times.
The Practice will make reasonable efforts to respond to messages within its posted time frames, but cannot guarantee immediate responses. Response times may vary based on clinical demands and physician availability.

8. Labs, Imaging, and Medications

8.1 Third-Party Services.
Laboratory tests, imaging, and medications are generally provided by independent third parties. These costs are not included in the membership fee unless expressly stated.

8.2 Discounted Pricing.
When possible, the Practice will help the Member access discounted or wholesale pricing for labs, imaging, and common medications. The Member is responsible for paying any third-party charges directly or through insurance.

8.3 Controlled Substances.
The Practice may have strict policies regarding the prescribing of controlled substances (e.g., opioids, benzodiazepines, stimulants). The Practice reserves the right, in its sole professional judgment, to refuse or limit such prescriptions.

9. Whole-Person and Hormonal Care

9.1 Whole-Person Approach.
The Practice’s philosophy is to treat the whole person—physical, mental, and spiritual—within the scope of family medicine. The Member may, at their discretion, discuss lifestyle, stress, mental health, and spiritual concerns, and the Practice will address these as appropriate or refer to other professionals when needed.

9.2 Hormonal Evaluation and Balance.
The Practice offers evaluation and management of hormonal health for both men and women, including concerns such as low testosterone, thyroid disorders, perimenopause/menopause symptoms, and related issues. Treatment plans may include lifestyle modification, non-pharmacologic interventions, medications, and/or referrals.

10. Privacy and Medical Records

10.1 Confidentiality.
The Practice will maintain the confidentiality of the Member’s medical information in accordance with applicable federal and state privacy laws.

10.2 Release of Records.
The Member authorizes the Practice to share information with other treating providers, laboratories, imaging centers, and pharmacies as necessary for treatment, payment (where applicable), and healthcare operations, subject to applicable law.

10.3 Access to Records.
The Member has the right to access and obtain copies of their medical records as provided by law and Practice policy.

11. Miscellaneous

11.1 Governing Law.
This Agreement is governed by the laws of the State of Connecticut.

11.2 Entire Agreement.
This Agreement constitutes the entire agreement between the parties regarding the DPC membership and supersedes any prior written or oral understandings concerning the same.

11.3 Amendments.
The Practice may amend this Agreement prospectively with reasonable written notice to the Member. Continued membership after the effective date of an amendment constitutes acceptance of the amended terms.

11.4 Severability.
If any provision of this Agreement is held invalid or unenforceable, the remaining provisions shall remain in full force and effect.

11.5 No Guarantee of Outcome.
The Practice does not guarantee any specific medical outcome or cure.

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