Service Agreement

Effective Date: [Auto-generated upon acceptance] · Version 1.9

This version (v1.9) supersedes prior versions for all claims initiated on or after the Effective Date. Claims initiated under prior versions of this Agreement continue to be governed by the version in effect at the time of acceptance.

1. Scope of Service

Credimed Inc. ("Credimed", "we", "us") provides a document preparation and submission support service for out-of-network dental insurance reimbursement claims.

We prepare, translate, itemize, and assist in submitting your claim on your behalf based solely on the documents and information you provide.

Credimed acts solely as an administrative support service. We are not a healthcare clearinghouse, healthcare provider, insurance company, third-party administrator (TPA), licensed insurance adjuster, or billing company.

We use third-party clearinghouses to transmit prepared claims to insurance carriers. Submission methods may vary depending on insurer requirements and available systems. We do not make coverage determinations, modify clinical information, or independently verify the accuracy of submitted materials.

Claim submissions are generally targeted within twenty-four (24) hours of receiving complete documentation and your signed authorization, but submission timing is not guaranteed and may vary based on system availability, insurer requirements, or document completeness.

Credimed reserves the right to refuse service where a claim cannot be reasonably processed or where misuse of the Service is suspected.

2. Pricing, Resubmissions, and Money-Back Guarantee

2.1 Pricing (System-Determined)

Credimed uses an automated pricing engine to determine claim complexity and assign a plan:

• Standard Plan — $49 USD
• Plus Plan — $79 USD
• Premium Plan — $99 USD

The assigned price is presented before payment and must be explicitly authorized by the Member.

The Member does not select the tier; pricing is determined based on claim characteristics.

Credimed does not charge any commission or percentage of your reimbursement. The plan fee, plus any optional resubmission fees, represents the full cost of the Service.

All fees are stated in U.S. dollars and are exclusive of any applicable taxes, which are the responsibility of the Member.

2.2 Resubmissions

If a claim is denied or requires correction:

• Standard: 1 resubmission included
• Plus: 2 resubmissions included
• Premium: Unlimited resubmissions for 12 months

Additional resubmissions (Standard/Plus only):

• $19 USD per attempt
• Require explicit Member authorization
• Capped at four (4) additional attempts per claim

All resubmissions:

• Must relate to the same claim
• Are subject to insurer deadlines and requirements
• Are performed only when Credimed determines, in its reasonable judgment, that a viable correction or submission strategy exists

Additional resubmission fees are non-refundable.

2.3 Money-Back Guarantee (100% Conditional Refund)

Credimed offers a conditional refund guarantee across all pricing tiers.

We will refund 100% of the plan fee if:

• The claim is eligible for reimbursement under your insurance policy; AND
• The claim is not paid after all Credimed-supported resubmissions.

Eligibility Determination

For purposes of this guarantee, eligibility for reimbursement is determined based on:

• The insurer's plan terms and coverage rules
• The documentation provided by the Member
• Standard coding practices

Credimed evaluates refund eligibility in good faith based on available claim data and insurer responses. Final coverage determinations remain solely the responsibility of the insurer.

Exclusions (No Refund)

The guarantee does NOT apply if denial is caused by:

• Deductibles, coinsurance, or out-of-network limitations
• Annual maximums, frequency limits, or waiting periods
• Plan exclusions
• Missing, incomplete, or inaccurate documentation
• Fraudulent or misrepresented information
• Failure to authorize necessary resubmissions within required deadlines

Partial Payment Rule

Any payment issued by the insurer, regardless of amount, constitutes a successful outcome. The plan fee is considered fully earned and non-refundable once any payment is made.

Final Denial

A claim is considered finally denied when:

• All included resubmissions have been completed; AND
• Credimed determines, in its reasonable judgment and in good faith, that no further viable submission strategy exists; OR
• The Member declines further reasonable resubmissions.

Refund Process

• Refunds are issued to the original payment method within 5–10 business days.
• Requests must be submitted within sixty (60) days of final denial determination.

Abuse Prevention

Credimed reserves the right, acting reasonably and in good faith, to deny refunds, suspend accounts, or limit access to the Service in cases of:

• Repeated refund requests across multiple accounts associated with the same individual or related parties
• Coordinated use of multiple accounts or repeated submission of substantially similar claims
• Suspected fraud, misrepresentation, or manipulation of the Service
• Attempts to circumvent pricing, resubmission limits, or refund eligibility conditions

3. Reimbursement Flow

All reimbursements are issued directly to you by your insurer.

Credimed does not receive, hold, or control reimbursement funds and is not a financial intermediary.

If funds are received in error, they will be promptly forwarded to you.

4. HIPAA & Data Handling

Credimed processes Protected Health Information ("PHI") solely to provide the Service.

We implement safeguards in compliance with applicable provisions of the HIPAA Security Rule, including encryption, access controls, and audit logging.

Where applicable, Credimed may act as a Business Associate under executed Business Associate Agreements.

We do not guarantee deletion of PHI where retention is required by law or regulatory obligations.

For full details, see our Privacy Policy and Notice of Privacy Practices.

5. Electronic Authorization

You authorize Credimed to:

• Prepare and submit your claim
• Communicate with your insurer for claim-related purposes
• Use your electronic signature in accordance with the E-SIGN Act (15 U.S.C. §§ 7001 et seq.)

6. Your Representations

You represent that:

• All submitted information is accurate and truthful
• Services were actually received and paid for
• No duplicate reimbursement exists
• You have authority to submit the claim
• You understand that Credimed cannot influence or guarantee your insurer's coverage determination, reimbursement timing, or payment amount

You agree to indemnify and hold harmless Credimed from any claims arising from inaccurate, incomplete, or fraudulent information provided by you.

7. Communications

You consent to receive transactional communications related to your claim via email, SMS, or messaging platforms (including WhatsApp). Message and data rates may apply.

You may opt out of SMS communications by replying STOP. Email will continue to be used for required notices.

Marketing communications require separate opt-in and will not include PHI.

8. Limitation of Liability

Credimed does not guarantee reimbursement outcomes.

To the maximum extent permitted by law, total liability is limited to fees paid within the last twelve (12) months.

Credimed is not liable for indirect, incidental, or consequential damages.

9. Governing Law and Disputes

This Agreement is governed by the laws of the State of Delaware.

Disputes are subject to the dispute resolution provisions set forth in the Credimed Terms of Service.

10. General Provisions

10.1 Severability

If any provision of this Agreement is found invalid or unenforceable, the remaining provisions remain in full force and effect.

10.2 Entire Agreement

This Agreement, together with the Privacy Policy, Terms of Service, and Notice of Privacy Practices, constitutes the entire agreement between you and Credimed and supersedes all prior or contemporaneous understandings.

10.3 Assignment

You may not assign your rights under this Agreement. Credimed may assign this Agreement to any successor entity in connection with a merger, acquisition, or sale of assets, provided the successor agrees to be bound by privacy and money-back-guarantee commitments at least as protective as those in effect at the time of assignment.

10.4 Amendments

Credimed may amend this Agreement from time to time. For material changes affecting Member rights or obligations, we will provide at least thirty (30) days' advance notice via email or through the Service.

10.5 No Waiver

Failure by Credimed to enforce any provision of this Agreement does not waive Credimed's right to enforce that provision later.

10.6 Force Majeure

Credimed is not liable for failures or delays caused by events beyond our reasonable control, including acts of God, natural disasters, government actions, network or infrastructure outages (AWS, Stripe, clearinghouse vendors, or insurer systems), labor disputes, or pandemics.

11. Contact

Credimed, Inc.
Boston, MA

Legal inquiries: legal@credimed.us
General support: support@credimed.us
Refund disputes: disputes@credimed.us
Privacy / HIPAA requests: privacy@credimed.us
Mailing address: [TO BE PROVIDED]

Related: Privacy Policy · Terms of Service · HIPAA Notice · Cookie Policy · Disclosures · Contact