Last Updated: June 28, 2023

‍Your healthcare provider has asked you to enroll in Wellvana Health's care management program. The platform includes a variety of tools, such as remote monitoring, appointment reminders, and educational information about your condition. Your healthcare provider and its business associates, including Wellvana, will use the platform to send you automated communications via SMS text messages to your phone, as well as emails to assist with your care and provide health information to you. You may also choose to send these messages to your healthcare provider. These messages may contain any and all protected health information your healthcare provider or its business associates determine necessary to help you with your care, including what kind of condition you have. Your information, such as your phone number, email, and other unique identifiers such as device identifiers may be used in connection with the platform and these messages.

Text messages and emails are not always encrypted throughout their transmission. There is some risk that the messages exchanged between you and your care team could be intercepted in transit and read by an unauthorized person. There is a risk that messages may not be delivered or that you may not receive the messages. Additionally, the messages from your health care provider may be available to anyone who has access to your phone or email, such as if they see a notification pop-up on your phone’s home screen. These messages may identify that you have a particular health condition. 

By responding “Y” or “Yes” to your enrollment text message, you are specifically requesting that your healthcare provider and its business associates, affiliates, and services providers communicate with you through unencrypted texts and other messages, and that you understand that there is a risk that your text messages could be read by unauthorized persons. If you choose not to receive these messages, your healthcare provider will continue to treat you and it will not affect your health plan enrollment or eligibility for health plan benefits, but you will not receive the benefits of texts and emails that assist you in navigating your care.

By responding “Y” or “Yes,” you agree that your healthcare provider and its business associates, affiliates, and services providers may send you recurring automated texts at the mobile number you provided, as well as emails, for purposes of your care management, as well as related to operations, payment, insurance, possible care alternatives, and marketing goods and services and other health-related benefits and options that may be of interest to you. Message and data rates may apply to texts. Text STOP to cancel; HELP for help.  Consent is not required to receive any treatment and is not a condition for any goods or services.

By responding “Y” or “Yes,” you also are confirming that you are 18 years or older and are legally able to enter into agreements on your own behalf. You further agree that your “Y” or “Yes” is your signature on this form.

In some cases you may be receiving and sending texts on behalf of another person, such as a child, parent, or partner, who is the patient of a health care provider. By responding “Y” or “Yes,” you are confirming that you have the legal right or authority or have obtained all necessary consents and authorizations to communicate on behalf of such other person with their health care provider and interact with Wellvana’s platform on their behalf. 

If you have questions about how your information may be used or shared, please see your health care provider’s notice of privacy practices.

We and our service providers may collect information about your use of our services by automated means, such as cookies, pixels, and other similar technologies. These tools can help us automatically identify you when you return to our services. They may also collect information about your interaction with our services, such as the date and time of use, pages visited and features used; device information, including the IP address and other details of a device you use to connect to our services; and your physical location information. They may help us review traffic patterns, improve our services, and determine what services are popular. We may share information obtained through these technologies with third party information technology companies, such as tracking vendors, that are not subject to HIPAA and that have not signed a business associate agreement with us agreeing to protect your data. By responding “Y” or “Yes,” you are also agreeing to our use of cookies, pixels, and similar technologies.

Once your information is disclosed as allowed on this form it may be re-disclosed by the recipient and privacy laws may no longer protect it. 

This authorization form will expire one year from the date you are no longer receiving services through the platform, unless a shorter period is required by law. This form will expire on the date required by such law. If you would like to revoke this permission before that, you may text STOP or reply to an email with STOP. Your revocation will not affect any actions taken before it is received.