Patient Agreement and Consent for Direct Billing or Deferred Billing

By agreeing to this Direct Billing or Deferred Billing section, you kindly consent to the following terms. We appreciate your understanding and cooperation as we work together to make your experience as smooth as possible.

We will first attempt to direct bill your private health insurance provider, if they allow it. If direct billing is not permitted, you authorize us to enroll you in our Deferred Billing Program. Under this program, we will extend to you 30 Days of Store Credit from the date you receive your order. This allows you to receive your supplies upfront without having to reimburse us for 30 days. You understand that the invoice you will receive for your supplies will reflect a zero-balance because the invoice was paid with Store Credit extended to you by One-Stop Medical Inc. but that the amount of Store Credit (which is equal to the amount of the invoice you received) will be due in full within 30 days from the date you receive your order, and understand that you have not paid anything on the date of your invoice and that credit extended to you will still require payment within 30 days.

You agree to submit the invoice to your insurance provider immediately upon receipt so that reimbursement can be processed as quickly as possible. Once you receive reimbursement from your private health insurance carrier, you agree to remit payment to us to pay off the 30 Day of Store Credit Extended to you (With the 30 Day Store Credit amount being equal to the full amount of the invoice) within those 30 days via e-transfer or debit (Debit may require you to visit one of our physical locations).

We also offer a Hardship Assistance Program that may help cover a portion of the cost for uninsured or underinsured patients. To be eligible, you must submit your claim to your insurance provider immediately (within 48-hours of being emailed the invoice) and contact us before the 30-day Store Credit period ends to discuss your situation and request assistance. If you do not make payment or contact us within 30-days from receiving your supplies and your invoice, you understand and agree to be personally responsible for the full invoice amount and understand that you will no longer qualify for any hardship assistance.

Late Payment Terms

If the full amount of the Store Credit (Or reduced amount if approved under our Hardship Assistance Program) extended to you is not paid within 30 days, you agree to the following:

• A late payment interest fee of 2% per month (equivalent to 24% per annum), calculated on the outstanding balance.
• If the account remains unpaid after 6 months from the invoice date, you agree to pay an additional 15% collections and administrative fee to help cover the costs of engaging a collection agency. This 15% fee is in addition to the monthly interest.

Credit Card on File Authorization

You give us explicit permission to charge the credit card you have on file at any time after the 30-day period if payment has not been received in full. You understand and agree that the amount charged will include:

• The full original invoice amount (equal to the store credit extended for the supplies you approved and received),
• A 4% Credit Card Processing Fee (to cover the fees charged to us by the credit card company), and
• Any accrued 2% Per Month (24% Per Annum) interest up to the date the card is charged.

You acknowledge that you were reimbursed (or are eligible to be reimbursed) by your Private Health Insurance Provider and that this payment arrangement helps us continue offering compassionate care and Hardship Support to others without incurring extra costs. Because you are being reimbursed by your private health Insurance Provider directly, we require you to forward this amount once paid by the Private health Insurance Provider immediately to us (and no later than 30 days after receiving the supplies) via e-Transfer or Debit. However if unable to reimburse us via e-Transfer or Debit and must pay us via Credit Card, you understand we will be required to charge you a 4% Processing Fee to cover the costs we incur for the fees charged to us by your credit card provider. We require payment for the credit card processing fee so that we do not have to use additional funds from our Hardship Assistance Program to cover these fees.

Collections and Legal Action

You understand and agree that you are fully responsible for the cost of all supplies you receive. If your account remains unpaid and must be referred for collection or pursued through legal proceedings (including small claims court), you consent to be responsible for all associated costs, including:

• The total amount of the 30-days of store credit extended to you (Equal to the original invoice amount),
• All accrued interest (2% per month / 24% per annum),
• The 15% collections and administrative fee (If the balance remains outstanding after 6 months, and
• All reasonable legal costs, such as court filing fees, process serving fees, paralegal or lawyer fees, and any other expenses incurred in recovering the amount owed.

We sincerely hope this situation never arises, and we are always available to discuss payment arrangements or hardship options in advance.

Responsibility for Supplies and Returns

You remain responsible for the full cost of all supplies delivered to you. Under our hardship program, we may be able to offer a discount of up to 25% per each medically necessary supply not covered by insurance; however, you are ultimately responsible for payment.

All stock supplies are returnable for a full refund provided they are unopened and in resaleable condition. However specially ordered supplies are not returnable. additionally CPAP, APAP and BiPAP machines are not returnable as they are covered under the Assistive Devices Program. For this reason, we recommend that you do not open any supplies until you have received reimbursement from your Private Health Insurance Provider. By opening any of the supplies you receive, you agree to accept full responsibility for payment.

If you choose to return any items:

• You may return them in person to any of our physical store locations, or
• You may ship them back at your own expense. In the case of shipping, you are responsible for all shipping and handling fees, as well as the full cost of any items lost or damaged in transit (unless you use a trackable shipping method and successfully file a claim with the carrier).

We truly value your trust and are committed to supporting your health needs. By agreeing to these terms, you confirm that you have read, understood, and accept full responsibility as outlined above.