Memorandum of Understanding
I understand and acknowledge the following SproutWell practice guidelines:
Patient Portal: You will be asked to register your child through our patient portal prior to the Initial Integrative Medicine Consultation. There are important forms and intake information that Dr. Julie Sweeney needs to review prior to the Initial Consultation. Following the Initial Consultation, all patient related communication and lab/data sharing should be handled through our secure patient portal to allow for encryption to protect your family's privacy. Please do not email our practice with personal medical information. If you do, we will respond to such messages through the patient portal- not through email.
Care Team/Communication: Dr. Sweeney is delighted to join your child's multidisciplinary care team. By signing this form, you acknowledge that each child must have a personal primary care provider for routine and sick care. Dr. Sweeney's review of medical records (medical history, labs, diagnosis and treatment), advice and integrative plan are based on this understanding. Our integrative-minded practice is designed to augment your child's pediatric care, not replace it. When given permission, Dr. Sweeney can communicate directly with your child's pediatrician, allergist, gastroenterologist and other specialists.
Insurance: Unfortunately, the practice does not accept patients covered by Medicare, Medicaid, HUSKY or any other government health care coverage. Further, we are "out of network" for all private insurance and do not bill any insurance plan for any services. For patients who may have out of network benefits as part of their coverage, you may be able to be reimbursed for services by submitting a detailed invoice or "superbill" to the insurance provider. Please note that we will provide a "superbill" for the Initial Integrative Medicine Consultation and the Annual Integrative Medicine Consultation only. If you would like to submit our invoice for reimbursement for the Initial Integrative Medicine Consultation and/or the Annual Integrative Medicine Consultation, please let us know at the time of your appointment. We regret that we cannot engage with insurance companies to determine coverage.
Annual Integrative Medicine Consultation: In order to remain as an established patient of SproutWell, your child must receive an Annual Integrative Medicine Consultation with Dr. Sweeney 1 year after the Initial Consultation and each year thereafter. The Annual Integrative Medicine Consultation is an in-person consultation payable at the time of service. If you wish, SproutWell will provide a superbill for you to submit to your child's health insurer for this visit. Patients who do not receive the Annual Integrative Medicine Consultation will be placed on inactive status, and you will not be able to schedule further appointments or consultations with Dr. Sweeney or receive prescription refills for your child. SproutWell may also require you to re-enroll your child in the practice if you do not schedule the Annual Integrative Medicine Consultation in a timely manner.
Fees: By signing below you understand and agree to our office fees as posted on our website under "FAQs + Pricing". Our fees are subject to change from time to time.
Annual Membership Package: The Annual Membership Package entitles patients to certain amenities for a yearly fee. This package is available to a limited number of families. The appropriate fit for the membership package is up to the discretion of Dr. Julie Sweeney. Please see our website for more details and for more information about what is included in our membership fees.
Payment: For those that do not join our Membership Package, you will be responsible for the full cost of your visit at the time of service. Please note that we require you to have a valid credit card on file. You can add a new card on file at any time by going to Payments and Invoices in the portal. If you add a card, please let us know which card you would like charged prior to your next appointment.
Cancellation Policy: Dr. Sweeney reserves your full appointment time exclusively for your child. If you need to cancel or reschedule, please do so at least 48 hours prior to the appointment. A fee of $100 will be charged for changes made less than 24 hours in advance of the scheduled appointment time.
Personalized Care Plans and Office Notes: After the Initial Consultation, a Visit Summary/Personalized Care Plan will be available through the patient portal. This plan will be updated after each follow up visit. Please note that SproutWell uses a service that transcribes conversations and helps with notes. This service is designed so Dr. Sweeney can focus on your child during the visit. Audio recordings are temporarily saved securely until note summaries and quality checks are complete and then they are automatically deleted. The service does not store protected health information and is HIPAA compliant. You may withdraw consent for this service at any time.
Multiple Children in a Family: Each child is unique and must be registered individually in the patient portal. Dr. Julie's consultations include coaching and empowering the whole family, but we ask that each appointment is primarily focused on one child at a time.
We look forward to meeting you and your child!