Terms of Service

1. Acceptance of Terms

By accessing or using the MedicareBilling.ai website and services, you agree to be bound by these Terms of Service ("Terms"). If you do not agree to these Terms, please do not use our services.

These Terms apply to all users of the Website, including without limitation users who are browsers, patients, family members, caregivers, healthcare providers, and authorized representatives.

2. Description of Services

MedicareBilling.ai provides the following services:

• Medicare bill review and analysis for patients and consumers
• Appeal preparation and support services
• Medicare Advantage denial assistance
• Provider services including denial recovery, RAC audit defense, and credentialing
• Educational resources and information related to Medicare billing

We are not affiliated with, endorsed by, or connected to the Centers for Medicare & Medicaid Services (CMS), the federal Medicare program, or any Medicare Advantage insurance plan.

3. Not Legal or Medical Advice

IMPORTANT: MedicareBilling.ai services do not constitute legal, medical, or professional advice. Our services are designed to help you understand and navigate Medicare billing processes, but we do not provide legal representation or medical advice.

For complex legal matters, you should consult with a qualified attorney. For medical decisions, you should consult with your healthcare provider. We recommend that you review all information we provide with qualified professionals before making decisions.

4. Patient Services Terms

4.1 Service Fees

Fees for patient services are as follows:

• Bill Review: $99 per review (for bills under $5,000)
• Full Appeal Help: $299 per case
• No-Risk Recovery: 30% contingency (fees apply only if savings are recovered)

4.2 Service Limitations

Our patient services are limited to Medicare billing review, dispute assistance, and appeal preparation. We do not provide legal representation. For cases requiring legal action beyond administrative appeals, we may refer you to qualified legal professionals.

4.3 Results Disclaimer

While we strive to provide accurate analysis and effective assistance, we cannot guarantee specific outcomes. Medicare decisions are made by Medicare contractors, Medicare Advantage plans, or Administrative Law Judges, and we have no control over these decisions. Past results do not guarantee future outcomes.

5. Provider Services Terms

For healthcare providers utilizing our services:

• Denial Recovery: 25% contingency fee on recovered amounts
• RAC Audit Defense: Flat fee engagement ($5,000-$25,000 depending on scope)
• Credentialing: $1,500 per provider, $2,500 for group enrollments

Provider engagements may require execution of separate service agreements. A Business Associate Agreement (BAA) is available upon request for covered services involving protected health information.

6. User Responsibilities

By using our services, you agree to:

• Provide accurate and complete information
• Obtain proper authorization when acting on behalf of another individual
• Comply with all applicable laws and regulations
• Not use our services for any unlawful purpose
• Protect the confidentiality of your account credentials
• Promptly notify us of any unauthorized use of your account

7. Privacy and HIPAA Compliance

Your privacy is important to us. Our collection, use, and protection of personal and health information is governed by our Privacy Policy and Notice of Privacy Practices.

We are committed to HIPAA compliance and maintain appropriate administrative, physical, and technical safeguards for protected health information.

8. Intellectual Property

All content on this website, including but not limited to text, graphics, logos, images, and software, is the property of MedicareBilling.ai or its content suppliers and is protected by United States and international copyright laws.

You may not reproduce, distribute, modify, or create derivative works from any content without our prior written consent.

9. Third-Party Links and Content

Our website may contain links to third-party websites or services that are not owned or controlled by MedicareBilling.ai. We have no control over, and assume no responsibility for, the content, privacy policies, or practices of any third-party websites or services.

You acknowledge and agree that we shall not be responsible or liable for any damage or loss caused by or in connection with the use of any such third-party content, goods, or services.

10. Disclaimer of Warranties

OUR SERVICES ARE PROVIDED "AS IS" AND "AS AVAILABLE" WITHOUT WARRANTIES OF ANY KIND, EITHER EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO IMPLIED WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, AND NON-INFRINGEMENT.

We do not warrant that: (a) our services will be uninterrupted, secure, or error-free; (b) the results obtained from the use of our services will be accurate or reliable; (c) the quality of any services will meet your expectations; or (d) any errors in the service will be corrected.

11. Limitation of Liability

TO THE MAXIMUM EXTENT PERMITTED BY LAW, IN NO EVENT SHALL MEDICAREBILLING.AI, ITS OFFICERS, DIRECTORS, EMPLOYEES, AGENTS, OR AFFILIATES BE LIABLE FOR ANY INDIRECT, INCIDENTAL, SPECIAL, CONSEQUENTIAL, OR PUNITIVE DAMAGES, INCLUDING WITHOUT LIMITATION, LOSS OF PROFITS, DATA, USE, GOODWILL, OR OTHER INTANGIBLE LOSSES, RESULTING FROM:

• Your access to or use of (or inability to access or use) our services
• Any conduct or content of any third party on the services
• Any content obtained from the services
• Unauthorized access, use, or alteration of your transmissions or content

IN NO EVENT SHALL OUR TOTAL LIABILITY EXCEED THE AMOUNT YOU PAID US FOR THE SPECIFIC SERVICE GIVING RISE TO THE CLAIM, OR ONE HUNDRED DOLLARS ($100), WHICHEVER IS GREATER.

12. Mandatory Arbitration and Dispute Resolution

12.1 Agreement to Arbitrate

You and MedicareBilling.ai agree that any dispute, claim, or controversy arising out of or relating to these Terms or your use of our services shall be determined by arbitration. This agreement to arbitrate is intended to be broadly interpreted and includes, but is not limited to:

• Claims arising out of or relating to any aspect of the relationship between you and us, whether based in contract, tort, statute, fraud, misrepresentation, or any other legal theory
• Claims that arose before these Terms or any prior agreement
• Claims that are the subject of purported class action litigation in which you are not a named class member

12.2 Exceptions to Arbitration

Notwithstanding the foregoing, either party may elect to have disputes heard in a small claims court if the disputes qualify. In addition, either party may bring suit in court seeking injunctive or other equitable relief related to intellectual property rights.

12.3 Arbitration Rules and Governing Law

The arbitration shall be administered by the American Arbitration Association (AAA) in accordance with its Commercial Arbitration Rules and the Supplementary Procedures for Consumer Related Disputes (if applicable), as modified by these Terms.

The arbitration shall be conducted in Minneapolis, Minnesota, in Hennepin County, and shall be governed by the laws of the State of Minnesota, without regard to its conflict of law provisions.

12.4 Arbitration Procedure

To begin an arbitration proceeding, you must send a letter that complies with the notice requirements of Section 15 and requests arbitration. You may obtain AAA forms and filing instructions from the AAA website at www.adr.org.

The arbitration shall be conducted by a single arbitrator, mutually selected by the parties, or if the parties cannot agree, appointed by the AAA. The arbitrator shall have the authority to award any remedy that a court of competent jurisdiction could award, subject to the limitations in these Terms.

12.5 Class Action Waiver

YOU AND MEDICAREBILLING.AI 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.

The arbitrator shall not consolidate another person's claims with yours or preside over any form of representative or class proceeding. If a court determines that this class action waiver is unenforceable, then this entire Section 12 shall be null and void.

12.6 Arbitration Fees

Payment of all filing, administration, and arbitrator fees shall be governed by AAA rules. If your claims are for $10,000 or less, we will pay all fees. If we believe your claim is frivolous, we may seek reimbursement of fees from you.

12.7 Confidentiality

The arbitrator shall maintain the confidentiality of the arbitration proceedings. All evidence and information disclosed during the arbitration shall be treated as confidential.

12.8 Opt-Out Right

You have the right to opt out of this arbitration agreement within 30 days of first accepting these Terms by contacting us in writing. To opt out, you must send written notice to our contact address below.

13. Indemnification

You agree to defend, indemnify, and hold harmless MedicareBilling.ai and its officers, directors, employees, contractors, agents, licensors, suppliers, successors, and assigns from and against any claims, liabilities, damages, judgments, awards, losses, costs, expenses, or fees (including reasonable attorneys' fees) arising out of or relating to your violation of these Terms or your use of our services.

14. Termination

We may terminate or suspend your access to our services immediately, without prior notice or liability, for any reason, including without limitation if you breach these Terms.

Upon termination, your right to use our services will cease immediately. All provisions of these Terms which by their nature should survive termination shall survive, including ownership provisions, warranty disclaimers, indemnification, and limitations of liability.

15. Notice

All notices and communications under these Terms shall be in writing and shall be deemed to have been duly given:

• When delivered personally
• When sent by email (with confirmation of receipt)
• One business day after being sent by nationally recognized overnight courier
• Three business days after being mailed by certified or registered mail

Notices to MedicareBilling.ai shall be sent to:
MedicareBilling.ai
Minneapolis, Minnesota
Hennepin County
Email: [email protected]

16. Governing Law

These Terms shall be governed by and construed in accordance with the laws of the State of Minnesota, without regard to its conflict of law provisions. Subject to the arbitration provisions in Section 12, any disputes shall be resolved in the state or federal courts located in Hennepin County, Minnesota.

17. Changes to Terms

We reserve the right to modify or replace these Terms at any time at our sole discretion. If a revision is material, we will provide at least 30 days' notice prior to any new terms taking effect. What constitutes a material change will be determined at our sole discretion.

By continuing to access or use our services after any revisions become effective, you agree to be bound by the revised terms.

18. Severability

If any provision of these Terms is held to be invalid, illegal, or unenforceable, the remaining provisions shall continue in full force and effect. The invalid or unenforceable provision shall be modified to the minimum extent necessary to make it valid and enforceable.

19. Entire Agreement

These Terms, together with our Privacy Policy and Notice of Privacy Practices, constitute the entire agreement between you and MedicareBilling.ai regarding your use of our services and supersede all prior agreements and understandings, whether written or oral.

20. Contact Information

If you have any questions about these Terms of Service, please contact us at: