Terms & Conditions
- We reserve the receive a retainer fee of a minimum of 5000.00 in advance to be wire transferred to secure service
- We reserve the right to receive a lump sum of up to 1 month of service in advance for long-term care security in the event there is an estate issue or probate to prevent mitigate the potential for losses or delays in payment
- We reserve the right to ask for a Financial Guarantor apart from the Estate or Patient for payment security
- Travel Services and Specialized Skills services bill at a higher rate
- Rates are based on complexity of need and risk factors
- Contracts and Month to Month agreements affect pricing
- We reserve the right to increase rates for service if the scope of needs or desires include additional services that are outside the scope of care of the caregiver.
- EX: a Home Health Aide is not a Home Maker but can act as both which raises the rate
- EX: an RN is not a companion but may double as a companion without conflicting with its legal scope of practice
- EX: a patient may have a partner or spouse that needs care, we reserve the right to add cost and do proper patient admission to avoid doubling service for the price of one
Items that may be required for service
- Initial Security Deposit
- Government Photo ID
- Major Credit Card
- Credit Card Authorization
- Statement of Financial Guaranty
- Service Agreement
- Long Term Care Contract
- Management Contract
- Healthcare Proxy
- Living Will
- NYS MOLST Form
- Patient Acknowledgements of the contents and rights within their Patient Handbook
We provide a pro bono greeting of up to 2 hours. We bill at an hourly rate of up to 350.00 per hour beyond the 2-hour pro-bono time.
We include the following in our Phase 1 Rapport/Discovery:
- Phone Greeting
- Discovery of needs and wants
- Patient History
- RN Advisory
- In-person greeting at the hospital, hotel or home
- Home Safety Assessment
We require an initial retainer deposit of up to 10,000.00 and/or a major credit card to secure advisory services beyond the pro bono period. The remaining balance of the retainer will either be returned if no future services are contracted or rendered or can be applied toward the initial service deposit or services provided.
Fees, Expenses and Invoicing
We will charge you for our services at our customary hourly rates for all distinct services. Other rates may include flat-rate services and management services. Our current invoicing rates, practices and terms and conditions are set forth in Enclosure 1 to this agreement. We will itemize and make available to you all related charges. We shall disclose expenses that may be accrued in advance prior to initiating them set for approval or denial.
We reserve the right to ask for additional funds for current or future services that may be called
- “ Retainer”
- “Service Security Deposit”
- “Holding Fee”
- “ Financial Guarantor”
We may ask for such fees in the form of Wire Transfer and/or Credit Card Preauthorization Holding on the card.
Invoicing for services will occur upon service engagement, retainers, approved expenses, added service security deposits, holding fees and for standard services such as advisory, consulting, management, visits, travel, live in or hourly care. Invoicing is typically on a biweekly basis on a Monday but may occur at any time.
You agree to pay invoices within 72hrs of receipt by the following approved methods of payment
- Major Credit Card on file with a 3.5% Convenience Fee
- Check FedX or similar 2-3 day air
- Bank Check 2-3 day air
- ACH Transfer
- Wire Transfer
If you can’t pay within the time frame above then we require a written reason to firstname.lastname@example.org explaining why and when payment will be rendered. We reserve the right to charge at an interest of 9% per annum on the balance owed (under New York state civil Practice Law Rules).
We reserve the right to use the “Service Deposit” or “Credit Card” for immediate or future unpaid balances or final services.
Termination of Services and Changes
You may terminate services in a written manner to the address 10 Herrick Drive Old Tappan, New Jersey 07675.
10 Herrick Drive Old Tappan, New Jersey 07675.
Attention: Patient Services
Correspondingly, if for any reason we feel the relationship with you is no longer suitable for either party, we may, upon written notice, terminate service with the contracted party(ies) by giving you
- Immediate or Next Day: 24hours
- Day to day, Month to Month: 72 Hours
- Contracted Services: Two weeks 14 days
In either event, we will be entitled to full payment for services rendered or owed at that time.
We will cooperate in discharging and transitioning care to your preferred legal caregiver.
If you terminate services, you are responsible for written notice and reason as well as complying with our policies above, termination of services time frames and fees to permit proper patient discharge and transition to the new caregivers. We reserve the right and will charge for the entire unused service period in the event there is a breach to these terms and conditions.
This letter will be effective upon receipt of a signed copy of our formal letter and a specified retainer amount shall be submitted to
Deposit Wire Account: provided
A Major Credit Card shall be held on file for payment security and you authorize a charge in a specified amount with a convenience fee of 3.5%.
Service Security Deposit
Service Security Deposits are held in a non-interest bearing account to secure end of service that may happen suddenly due to permanent hospitalization or death. In certain cases estates freeze all accounts limiting or preventing all medical bills from being paid.
A financial guarantor may be a person outside the estate willing to pay for all medical bills on behalf of the contracted party/patient. We reserve the right to ask for such consent to such a guarantor.
Optional Holding Fees are billable at 50% of the hourly, weekly or monthly service rates in order to secure that your caregiver or caregiver team, management will remain as yours. This insures that the patient does not lose their dedicated person or team in the event there is a desire or need to suspend service due to travel or temporary hospitalization.
In the event no Holding Fee is requested, no further charges will be accrued, however with respect to our caregivers, their loyalty and need to work, they may take a contract with another patient.
This Holding Fee is designed to insure that your team remains your for the entirety of your care need.
Apart from this agreement, a more specific patient service contract may be required that would be inclusive of
- Tiered Dignitary RN Management Services
- Daily Visits
- 12/24 Long Term Care Month to Month or Annual Contract
- Live-In Service
- Travel Service
Quality Assurance and Disputes
Our Agency-Patient relationship is confidential. We act as the fiduciary to the patient’s well-being and care. We follow lawful homecare and clinical services practices illustrated in the Patient Handbook that discloses patient rights, homecare rights and the rights of our caregivers.
Our primary duty is to do no harm and provide legal and competent service to the patient. We oversee all care to the patient that aims to prevent any foul play or undermining of care to the patient.
We are a service and quality-driven organization that can handle disputes reasonably and diplomatically to ensure the outcome we both seek.
We practice full transparency in our care practices and billing practices. If you have any questions, comments or issues, we encourage you to communicate with your Care Manager so we can rectify the issue before it escalates.
We do not anticipate disputes. However, the rules governing disputes or complaints regarding our practices in NYS
As a home care client, you have the right to voice and submit complaints and dissatisfaction about the care and services provided or not provided by:
GLOBAL PRIVATE HOME CARE LIMITED LIABILITY COMPANY
The procedure to submit your complaints are as follows:
- Call the agency at (866) 863-6800
- Ask for the Patient Services or Director of Operations
- . Explain your concerns
The agency will investigate your allegations within 15 days of receipt of a complaint. Also, if dissatisfied with the outcome, you may submit and appeal to the agency’s governing authority. All appeals will be reviewed within 30 days upon receipt of the appeal request.
In New York State, home care clients may also submit complaints to the Department of Health. If you are dissatisfied with the outcome of our complaint resolution, you may also submit the complaint to the New York State Department of Health or any outside representative of the client’s choice.
NYS Department of Health
Metropolitan Regional Office
90 Church Street
New York, NY 10007
The expression of such complaints by the client or client designee shall be free from interference, coercion, discrimination, or reprisal.
If a dispute arises between the agency and the contracted parties regarding our fees, expenses, services or any matter between us, you agree that the prevailing party is responsible for all reasonable expenses and legal costs.
Patient Medical Records and Clinical Notes
You agree to sign a HIPAA agreement to release medical records pertaining to the patient’s care, permit a physician order for care and to not tamper, alter or prevent VIPrivate Care from its clinical records.
Clinical notes/records must be stored and kept from any person other than the contracted caregivers themselves or its management.
We require immediate return of all Clinical Notes/records for legal purposes.
HIPAA, Patient and Home Care Rights
Please see the NYS Patient Handbook
The Agreement shall be governed by, construed in accordance with, The Laws of the State of New York notwithstanding any conflict-of-laws doctrine to the contrary. This agreement may be executed and delivered by fax to 646-219-4593 and/or scanned and emailed to email@example.com or mailed to 10 Herrick Drive Old Tappan, NJ 07675 and will be binding whether executed manual in the original or by other means and may be legally executed by a DPOA, POA or Spouse or legal party related to the patient.
This agreement represents legal Home Care and Concierge Nursing services to the party.
In terms set forth in any Agreement are satisfactory, please sign and date a copy of the agreement and return by the means sated above.
Should you have any questions or changes to this agreement, please call 646.926.3113 and speak to Patient Services to avoid any misunderstanding or misinterpretation concerning this engagement.