Silver House: Legal

Commitment to Affordable Healthcare

This is a policy of Silver House Healthcare LLC (“we,” “us,” “our,” or “Silver House”) and applies to its Collaborative Care Communities, which include but are not limited to MemoryWatch™, Circles™, and BATWatch™. These communities are collectively or individually referred to as (our “Community,” “MemoryWatch,” “Circles,” or “BATWatch”).

Each Collaborative Care Community has been specifically developed to target distinct stages and aspects of cognitive health management:

• MemoryWatch™ is a program that focuses on supporting individuals and families impacted by cognitive decline or dementia, providing access to a vast network of healthcare providers, assisted living facilities, and support systems tailored to these needs.
• Circles™ is a program that serves those in the pre-clinical stages of cognitive decline, offering social, lifestyle, and wellness activities aimed at promoting cognitive health early in life to prevent chronic stress and long-term decline.
• BATWatch™ is a program designed to empower healthcare providers by offering resources and collaborative frameworks to support early detection and management of Alzheimer’s through BAT Levels™ monitoring, testing, and treatment.

By enrolling or participating in any of these communities, all Members agree to abide by the terms outlined herein and any specific community-based guidelines related to their care or services.

We are committed to ensuring that financial barriers do not prevent our patients from accessing essential cognitive health services. Our Financial Assistance Program (FAP) is designed to assist you in managing out-of-pocket expenses for services provided by Silver House and other providers within our Community, including labs, imaging centers, and specialty healthcare services.

Financial Assistance Program (FAP)

Our FAP offers automatic assistance to reduce or eliminate out-of-pocket costs such as copays, coinsurance, or deductibles. This applies to services provided by Silver House, as well as by our trusted partnered lab providers in the Community.

Eligible patients will have financial assistance applied during the billing process. You have the right to revoke authorization at any time by providing written notice, but doing so may limit the financial assistance available for future services.

Billing Process and Insurance Coverage

For all services, your insurance will be billed first. Once insurance has processed the claim, any remaining costs (such as copays or deductibles) will be addressed as follows:

• Silver House and Community Providers: If financial assistance applies, Silver House will cover remaining costs through our FAP. Partner providers within the Community will follow a similar process.
• MemoryWatch Foundation, Silver House Foundation, or other partners organization Grants, (“Organizations”): Should further assistance be required, the Organizations may step in to cover outstanding balances, ensuring that patients do not face financial hardship.

Working with Providers in the Community

As part of our commitment to continuity of care, Silver House collaborates with a broad Community of providers within the Community. These providers may include specialists, labs, imaging centers, and telehealth services that contribute to your cognitive health care. The FAP covers eligible costs across this Community, ensuring that you have access to a wide range of services with minimal or no financial burden.

For example:

• Lab Services: Some labs offer critical BAT testing options. Silver House’s FAP may cover copays or deductibles, and remaining balances may be eligible for coverage by the Organizations.
• Therapy Services: If you receive therapies like physical therapy, occupational therapy, or speech-language pathology from Community providers, your costs will be managed under the FAP where applicable.

Organization Grants

The Organizations are separate charitable Organizations that provides grants to cover any remaining out-of-pocket expenses once the FAP has been applied. This ensures compliance with the Anti-Kickback Statute (AKS) and insurance billing regulations, providing patients with the financial support needed to cover their care.

• No Out-of-Pocket Costs: After your insurance has been billed and financial assistance applied, the Organizations can provide grants to cover the remaining balance.
• Reimbursement: In certain cases, such as with our partnered lab providers, patients may need to submit their bill to the Foundation for reimbursement. Reimbursement will cover up to 100% of your out-of-pocket expenses for eligible services.

Why This Process Works This Way:

Due to legal requirements and regulations surrounding insurance and the Anti-Kickback Statute (AKS), we follow this process to ensure compliance. Insurance will not cover the cost of medical services provided, and financial assistance kicks in next, and then grants, and all must be provided in a compliant manner.

We believe medical services should be widely available to everyone, regardless of financial circumstances. Therefore, our FAP and the Organization Grants reimburse patients directly after they receive their bills, ensuring that all assistance remains within the boundaries of legal regulations.

Patient Responsibilities

• Accurate Insurance Information: You are responsible for providing accurate insurance information and updates. Failure to do so may result in financial liability.
• Verification of Benefits: We will attempt to verify your benefits, but it remains your responsibility to understand your insurance coverage, including any limitations or exclusions.
• Financial Responsibility: If services are not covered by insurance, your responsibility will be capped at $25 per encounter for specific services like Prime™ and TherapySpace™ encounters. You are also responsible for any costs that are not covered by the FAP or Organization Grants.

Invoice Submittals: Once you receive your bill from any Community provider, expected within 2-3 months after testing is completed, please email the bill to grants [at] silverhouse [dot] health for reimbursement. We will promptly confirm the bill and issue a reimbursement check for the approved amount.

Billing and Payment

Once insurance and financial assistance have been applied, you will be responsible for any remaining balance up to the cost cap. Payment options include cash, check, and credit card. In the event that Silver House or a Community provider does not contract with your insurance, you will be billed directly but may submit a claim for reimbursement from your insurance company.