Administrative Processing & Handling Reimbursement Fee Agreement for Physicians

Administrative Processing & Handling Reimbursement Fee Agreement

  • This Administrative Processing & Handling Fee Agreement between Evicting Cancer and
  • herein after referred to as Physician, is made effective
  • Date Format: MM slash DD slash YYYY
  • with regards to Taking Your Life Back from Cancer orders taken and processed in or through the physician’s practice and entered into the enrolling website https://evictingcancer.com/physician-partner-enrollment-form/
  • A. Evicting Cancer will reimburse Physician an Administrative Processing and Handling fee of $100.00 per correctly entered order for each patient who completes the program. This fee also represents payment for the displaying and distributing of fliers, brochures etc. and the time spent to provide Evicting Cancer with the appropriate and completed order forms and necessary billing information. The physician will not receive a fee for patients who request and receive a refund.

    B. The physician agrees to not bill the patient and/or collect from any commercial insurance and government payers such as Medicare, Tricare or Medicaid programs for any of the above mentioned services.

    C. Physician ensures that all patients enrolled on the enrolling website by the physician’s office have:
    a. agreed to be enrolled in Taking Your Life Back from Cancer
    b. agreed to have their credit card charged
    c. provided authorization to have the information shared with Evicting Cancer

    D. Evicting Cancer has instituted an automatic processing and handling payment system that eliminates the need for invoicing Evicting Cancer for patients enrolled in Taking Your Life Back from Cancer. Evicting Cancer will generate a list of your patients who paid and participated in the program for Physician each month and process payment based on Physician’s contracted Process and Handling fee, as set forth herein, within 30 days of each month’s close of business.

    E. This Agreement shall continue until terminated by either party upon fifteen (15) days written notice to the other party.