Terms of Service

1. Acceptance of Terms

By creating an account, accessing, or using MedAppeals (the "Platform" or "Service"), you acknowledge that you have read, understood, and agree to be bound by these Terms of Service and our Privacy Policy. These Terms apply to all users, including healthcare providers, practice administrators, and other authorized personnel.

1.1 Agreement Scope

• These Terms govern your use of all MedAppeals services, features, and functionality
• Additional terms may apply to specific features or services
• Your organization may have a separate Business Associate Agreement (BAA) that supplements these Terms

2. Service Description

MedAppeals is an artificial intelligence-powered platform designed to assist healthcare providers in generating insurance appeal letters. Our services include:

2.1 Core Services

• AI-Powered Appeal Generation: Automated creation of insurance appeal letters based on medical documentation
• Document Processing: Secure upload and processing of medical documents with PHI de-identification
• Medical Similarity Search: Vector-based matching of similar successful appeals for enhanced generation
• Multi-tenant Provider Management: Organization-level account management and user administration
• Real-time Processing: Job queue management and status tracking for appeal generation

2.2 AI and Machine Learning

• Our platform uses advanced AI models, including Azure OpenAI services
• AI training occurs on de-identified medical content (with provider consent)
• Generated appeals are suggestions and require professional review
• System performance improves through anonymized feedback and usage patterns

3. Medical and Legal Disclaimers

3.1 Medical Disclaimers

• Not Medical Advice: Our platform does not provide medical advice, diagnosis, or treatment recommendations
• Professional Judgment Required: All generated appeals must be reviewed and approved by qualified healthcare professionals
• Medical Accuracy: Users are responsible for verifying the medical accuracy of all generated content
• Patient Care Decisions: The platform does not influence or recommend patient care decisions

3.2 Legal Disclaimers

• Not Legal Advice: Generated appeals are not legal advice and do not create an attorney-client relationship
• Regulatory Compliance: Users are responsible for ensuring compliance with all applicable healthcare regulations
• Appeal Success: We do not guarantee that appeals will be successful or that claims will be approved
• Professional Review: All appeals should be reviewed by qualified personnel before submission

3.3 AI Limitations

• Technology Limitations: AI-generated content may contain errors, omissions, or inaccuracies
• Human Oversight Required: All AI-generated content requires human review and validation
• Evolving Technology: AI capabilities and accuracy may change over time
• Training Data Bias: AI models may reflect biases present in training data

4. Eligibility and Account Requirements

4.1 User Eligibility

• Healthcare Professionals: Must be licensed healthcare providers, practice administrators, or authorized personnel
• Age Requirement: Must be at least 18 years of age
• Authority: Must have authority to bind your organization to these Terms
• Geographic Restrictions: Service is available only in jurisdictions where legally permitted

4.2 Account Security

• Accurate Information: Provide accurate, current, and complete account information
• Password Security: Maintain strong, unique passwords and enable multi-factor authentication
• Account Responsibility: You are responsible for all activities under your account
• Unauthorized Access: Immediately notify us of any unauthorized account access

4.3 Organization Accounts

• Healthcare organizations may establish provider accounts with multiple users
• Admin users have authority to manage organization settings and user access
• Organizations are responsible for their users' compliance with these Terms

5. Acceptable Use Policy

5.1 Permitted Uses

• Generate appeal letters for legitimate medical insurance claims
• Process medical documents for appeal generation purposes
• Use training features to improve AI models (with proper consent)
• Manage organizational appeal workflows and user access

5.2 Prohibited Uses

You may not use our platform to:

• Fraudulent Activities: Create false or fraudulent appeals or claims
• Unauthorized Access: Access accounts, data, or systems without authorization
• Data Misuse: Use patient data for purposes other than appeal generation
• System Abuse: Attempt to disrupt, damage, or overload our systems
• Reverse Engineering: Reverse engineer, decompile, or attempt to extract our AI models
• Competitive Intelligence: Use our service to develop competing products or services
• Spam or Abuse: Send unsolicited communications or engage in abusive behavior

5.3 Data Quality and Accuracy

• Upload only accurate and legitimate medical documentation
• Ensure all uploaded documents are properly authorized for processing
• Do not upload non-medical content or irrelevant information
• Verify that documents are readable and contain relevant medical information

6. HIPAA and Healthcare Compliance

6.1 Business Associate Relationship

• MedAppeals serves as a Business Associate under HIPAA for covered entities
• We maintain appropriate safeguards for Protected Health Information (PHI)
• Separate Business Associate Agreements (BAAs) may be required for certain organizations
• We comply with all applicable HIPAA requirements for PHI handling

6.2 PHI De-identification

• Our system automatically removes direct patient identifiers before AI processing
• Medical content relevant to appeals is preserved during de-identification
• Users remain responsible for ensuring appropriate authorization for document processing
• De-identified data may be used for AI training and improvement (with consent)

6.3 User Responsibilities

• Authorization: Ensure proper authorization before uploading patient documents
• Minimum Necessary: Upload only information necessary for appeal generation
• Organizational Policies: Comply with your organization's privacy and security policies
• Breach Reporting: Report any suspected privacy or security incidents immediately

7. Intellectual Property Rights

7.1 Our Intellectual Property

• Platform Ownership: We own all rights to the MedAppeals platform, including software, AI models, and algorithms
• Trademarks: "MedAppeals" and related marks are our trademarks
• Trade Secrets: Our AI models, algorithms, and methods are proprietary trade secrets
• Patents: We may hold or apply for patents on our technology innovations

7.2 Your Content and Data

• Document Ownership: You retain ownership of medical documents you upload
• Generated Appeals: You own the specific appeal content generated for your use
• License to Process: You grant us a license to process your data to provide our services
• De-identified Data: We may use de-identified, anonymized data for AI training and improvement

7.3 AI Training Data

• Participation in AI training is optional and controlled through provider settings
• Only positively-rated, de-identified appeals contribute to training data
• Training data becomes part of our collective knowledge base for all users
• Individual contributions cannot be extracted from trained models

8. Subscriptions and Billing

8.1 Subscription Plans

• Plan Types: Various subscription tiers with different features and usage limits
• Billing Cycles: Monthly or annual billing cycles as selected during signup
• Auto-Renewal: Subscriptions automatically renew unless cancelled
• Plan Changes: You may upgrade or downgrade plans through your account dashboard

8.2 Payment Terms

• Payment Processing: Payments processed securely through Stripe
• Payment Methods: Credit cards and ACH transfers accepted
• Currency: All prices in US Dollars unless otherwise specified
• Tax Responsibility: You are responsible for applicable taxes

8.3 Refunds and Cancellations

• Cancellation: Cancel subscription anytime through your account dashboard
• Service Continuation: Service continues until the end of the current billing period
• Refund Policy: Generally no refunds for partial months, except for billing errors
• Data Access: Account data remains accessible for 30 days after cancellation

8.4 Usage Limits and Overages

• Each plan includes specific usage limits for appeal generations
• Overage charges may apply for usage exceeding plan limits
• Usage resets at the beginning of each billing cycle
• Enterprise plans may have custom usage agreements

9. Data Usage and AI Training

9.1 Data Processing Consent

• Service Delivery: We process your data to provide appeal generation services
• AI Training Opt-in: Participation in AI training requires explicit consent
• De-identification: All AI training uses de-identified medical content only
• Quality Control: Only positively-rated appeals contribute to training data

9.2 Training Data Contributions

• Provider organizations can opt into training data contribution
• Individual users can provide feedback (thumbs up/down) on generated appeals
• Positive feedback on high-quality appeals improves our AI models
• Training contributions benefit the entire user community

9.3 Data Security in Training

• All training data is thoroughly de-identified before use
• No direct patient identifiers are used in AI training
• Medical content and clinical context are preserved for training effectiveness
• Trained models cannot be reverse-engineered to extract individual cases

10. Platform Availability and Maintenance

10.1 Service Availability

• Uptime Goal: We strive for 99.5% uptime but do not guarantee continuous availability
• Maintenance Windows: Scheduled maintenance will be announced in advance
• Emergency Maintenance: Unscheduled maintenance may occur for security or stability reasons
• Third-Party Dependencies: Availability may be affected by third-party service providers

10.2 Performance and Limitations

• Processing Time: Appeal generation typically completes within 2-5 minutes
• File Size Limits: Document uploads limited to 50MB per file
• Concurrent Requests: Platform may limit concurrent processing to ensure fair usage
• Storage Limits: Account storage limits vary by subscription plan

10.3 Platform Updates

• We regularly update platform features and AI models
• Major changes will be communicated to users in advance
• Security updates may be deployed without prior notice
• Feature changes aim to improve user experience and outcomes

11. Limitation of Liability

11.1 Disclaimer of Warranties

TO THE MAXIMUM EXTENT PERMITTED BY LAW, MEDAPPEALS PROVIDES THE PLATFORM "AS IS" AND "AS AVAILABLE" WITHOUT WARRANTIES OF ANY KIND, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHERWISE, INCLUDING BUT NOT LIMITED TO:

• IMPLIED WARRANTIES OF MERCHANTABILITY
• FITNESS FOR A PARTICULAR PURPOSE
• NON-INFRINGEMENT
• UNINTERRUPTED OR ERROR-FREE OPERATION
• ACCURACY OR COMPLETENESS OF AI-GENERATED CONTENT

11.2 Limitation of Damages

TO THE MAXIMUM EXTENT PERMITTED BY LAW, IN NO EVENT SHALL MEDAPPEALS BE LIABLE FOR:

• Consequential Damages: Lost profits, lost revenue, lost data, or business interruption
• Indirect Damages: Any indirect, incidental, special, or punitive damages
• Appeal Outcomes: Denial of insurance claims or unsuccessful appeals
• AI Errors: Inaccuracies or errors in AI-generated content
• Third-Party Actions: Actions or decisions by insurance companies or other third parties

11.3 Liability Cap

OUR TOTAL LIABILITY TO YOU FOR ALL CLAIMS ARISING FROM OR RELATING TO THESE TERMS OR THE PLATFORM SHALL NOT EXCEED THE AMOUNT YOU PAID TO US IN THE 12 MONTHS PRECEDING THE CLAIM, OR $1,000, WHICHEVER IS GREATER.

11.4 Medical and Legal Outcome Disclaimer

• We do not guarantee that appeals will be successful or that insurance claims will be approved
• Appeal success depends on many factors outside our control
• Users are responsible for verifying accuracy and appropriateness of all generated content
• Professional medical and legal judgment should be applied to all generated appeals

12. Indemnification

You agree to indemnify, defend, and hold harmless Medical Appeals AI, its officers, directors, employees, agents, and affiliates from and against all claims, demands, losses, liabilities, costs, and expenses (including reasonable attorneys' fees) arising from or relating to:

• Your use of the platform in violation of these Terms
• Your violation of any applicable laws or regulations
• Your violation of any third-party rights, including privacy, publicity, or intellectual property rights
• Any unauthorized access to or use of your account
• Any content you submit, upload, or otherwise make available through the platform
• Your breach of any representation or warranty contained in these Terms

13. Termination

13.1 Termination by You

• You may terminate your account at any time through your account dashboard
• Termination does not entitle you to a refund for the current billing period
• You remain responsible for all charges incurred before termination
• Your data will be retained for 30 days after termination for recovery purposes

13.2 Termination by Us

We may terminate or suspend your account immediately if:

• You violate these Terms or our Acceptable Use Policy
• Your account is used for fraudulent or illegal activities
• You fail to pay required fees after notice and opportunity to cure
• Your use poses a security risk to our platform or other users
• We are required to do so by law or legal process

13.3 Effect of Termination

• Upon termination, your right to use the platform immediately ceases
• We will provide data export capabilities for 30 days after termination
• All provisions of these Terms that should survive termination will continue to apply
• Termination does not affect any liability or obligation incurred before termination

14. Governing Law and Dispute Resolution

14.1 Governing Law

These Terms are governed by and construed in accordance with the laws of the State of Delaware, United States, without regard to conflict of law principles.

14.2 Dispute Resolution Process

1. Direct Communication: First attempt to resolve disputes through direct communication with our support team
2. Informal Resolution: If direct communication fails, we will attempt informal resolution for 60 days
3. Binding Arbitration: Unresolved disputes will be settled through binding arbitration

14.3 Arbitration Rules

• Arbitration conducted under the Commercial Arbitration Rules of the American Arbitration Association
• Arbitration will be conducted by a single arbitrator in Atlanta, Georgia
• Each party responsible for their own costs and attorneys' fees
• Arbitration awards are final and binding on both parties

14.4 Class Action Waiver

YOU AGREE THAT ANY DISPUTE RESOLUTION PROCEEDINGS WILL BE CONDUCTED ON AN INDIVIDUAL BASIS AND NOT IN A CLASS, CONSOLIDATED, OR REPRESENTATIVE ACTION.

15. Modifications to Terms

15.1 Changes to Terms

• We may modify these Terms at any time to reflect changes in law, technology, or business practices
• Material changes will be communicated via email and platform notifications
• You will have 30 days to review changes before they become effective
• Continued use of the platform constitutes acceptance of modified Terms

15.2 Notification Process

• Email Notice: Changes sent to the email address associated with your account
• Platform Notice: In-app notifications about important changes
• Website Posting: Updated Terms posted on our website with effective date
• Version History: Previous versions maintained for reference

15.3 Rejection of Changes

• If you do not agree to modified Terms, you may terminate your account
• Termination due to Terms changes does not entitle you to a refund
• Data export will be available for 30 days after termination

16. Miscellaneous Provisions

16.1 Entire Agreement

These Terms, together with our Privacy Policy and any applicable Business Associate Agreement, constitute the entire agreement between you and MedAppeals regarding the platform.

16.2 Severability

If any provision of these Terms is found to be unenforceable, the remaining provisions will continue in full force and effect.

16.3 Assignment

• You may not assign these Terms or your account without our written consent
• We may assign these Terms in connection with a merger, acquisition, or sale of assets
• These Terms bind and benefit the parties' successors and permitted assigns

16.4 Force Majeure

Neither party will be liable for delays or failures in performance due to causes beyond their reasonable control, including natural disasters, government actions, or network failures.

16.5 Language

These Terms are written in English. In case of conflicts between English and translated versions, the English version controls.

17. Contact Information