Telehealth Informed Consent

Purpose

This document summarizes the telehealth services offered by Optum Store, the benefits and risks associated with using telehealth and your responsibilities and rights. Optum Store has contracted with Truepill and its affiliated and contracted medical groups to provide these services. 

Description of Services

Telemedicine involves the use of audio, video or other electronic communications to interact with you, consult with your healthcare provider and/or review your medical information for the purpose of diagnosis, therapy, follow-up and/or education. Telehealth services may be provided by a variety of healthcare practitioners including nurse practitioners, physician assistants, physicians, specialists and/or subspecialists, and other non-physician healthcare providers (“Providers”). During your telemedicine consultation, details of your medical history and personal health information will be discussed with you through the use of interactive video. 

You enjoy a medical provider-patient relationship with the individual participating in your care remotely via telemedicine.

All current confidentiality protections under federal and state law apply to information collected and disclosed during the telemedicine interaction. Electronic systems used will incorporate network and software security protocols to protect the privacy and security of health information and will include measures to safeguard the data to ensure its integrity against intentional or unintentional corruption. 

In some cases, telemedicine visits may not be the most appropriate way for you to seek medical care and treatment.  For example, certain medical conditions may require an in-person consultation or more urgent attention at a hospital.

Benefits and Risks

Your use of the Services may have the following possible benefits:

• Making it easier and more efficient for you to seek medical care and treatment for the conditions treated by the applicable healthcare provider;

• Allowing you to seek medical care and treatment by your Provider at times that are convenient for you; and

• Enabling you to communicate with your Provider without the necessity of an in-office appointment.

Risks and Limits

As with any medical procedure or interaction, there are potential risks and limitations associated with the use of telemedicine. These risks include, but may not be limited to:

• In rare cases, information transmitted may not be sufficient (e.g., poor resolution of images) to allow for appropriate medical decision making by the provider.

• Delays in medical evaluation/treatment could occur due to deficiencies or failures of the electronic equipment.

• In rare instances, security protocols could fail, causing a privacy issue regarding your personal medical information.

• In rare cases, a lack of access to all of your medical records may result in adverse drug interactions or allergic reactions or other judgment errors.

Your Payment Responsibility 

Please note that your telehealth visit is not covered by insurance. You agree that you are: (i) fully responsible for payment for all fees billed to you related to telemedicine visits; and (ii) responsible for asking any questions that you may have about and fully understanding your financial responsibility before using the Services.  Please reach out to support@store.optum.com for any questions regarding fees and billing for telemedicine visits.

By clicking “Continue”, you also acknowledge the following:

• Your Provider has discussed the use of telemedicine services with you, including the benefits and risks of such use and the alternatives to the use of the Services, and you have provided consent to your Provider for the use of the Services.

• You understand that it is your duty to provide your Provider truthful, accurate, and complete information, including all relevant information regarding care that you may have received or may be receiving from other healthcare providers or outside of the Services.

• You understand that your Provider may determine that your condition is not suitable for diagnosis or treatment using the Services, or may fail to respond promptly or ever to your request for a telemedicine service, and that you may need to seek medical care and treatment from your Provider, a specialist, or other healthcare provider outside of the Services.

• You understand the risks and benefits of the Services and its use in the medical care and treatment provided to you by your Provider.

• No potential benefits from the use of the Services, care provided via the Services, or specific results can be guaranteed.  

• You understand that you can withhold or withdraw this consent at any time by emailing support@store.optum.com  with such instruction. Otherwise, this consent will be considered renewed upon each new telemedicine consultation with Providers.

• You acknowledge that you have received and read the Notice of Privacy Practices, and you understand how your personal information will be used.

Acknowledgement

By clicking “Continue”, you (a) certify that you are the patient, or that you are duly authorized by the patient as the patient’s representative or legal guardian, (b) acknowledge and accept the risks identified above and the terms associated with the receipt of telemedicine services, and (c) give your informed consent to receive telemedicine services.