HIPAA Authorization & Authorized Representative Designation

⚠️ IMPORTANT LEGAL DISCLOSURE: Under HIPAA regulations, healthcare providers cannot disclose Protected Health Information without a valid authorization. By checking the agreement boxes during signup, you digitally execute this document, appointing ApproveIt as your authorized representative to communicate with your insurers.

🏥 01. Authorization to Disclose Protected Health Information (PHI)

Pursuant to the Health Insurance Portability and Accountability Act of 1996 (HIPAA) regulations at 45 CFR Parts 160 and 164, you hereby authorize your healthcare providers (physicians, clinics, hospitals) and your health insurance payer (medical director, claims processing center) to disclose your Protected Health Information (PHI) to ApproveIt Inc. for the purpose of analyzing, compiling, and submitting appeals.

📋 02. Scope of Protected Health Information Covered

This authorization applies to all medical, clinical, and financial records necessary to fight your insurance denial. This includes, but is not limited to: insurance denial letters, Explanation of Benefits (EOB), prior authorization requests, physicians' clinical notes, diagnostic test results, imaging reports, billing statements, and treatment plans.

⚖️ 03. ERISA Authorized Representative Designation

Under Section 502(a)(1)(B) of the Employee Retirement Income Security Act of 1974 (ERISA) and applicable state laws, you formally designate ApproveIt (and its clinical staff) as your Authorized Representative. This authorizes ApproveIt to: (a) file internal prior authorization appeals on your behalf, (b) file external independent reviews (IRO), (c) submit regulatory complaints to state insurance commissioners, and (d) obtain all communication from your insurance payer regarding your case.

⏳ 04. Right to Revoke & Expiration Date

You have the right to revoke this authorization in writing at any time by sending an email to support@approvelt.com. Revocation will be effective upon receipt but will not apply to any actions or disclosures already taken in reliance on this authorization. Unless revoked earlier, this authorization will automatically expire exactly one (1) year from the date you signed the terms or upon the final resolution of your active appeal cases.

🔒 05. Re-disclosure Disclaimer

We scrub all medical documents from our databases within 90 days of case closure. However, you acknowledge that information disclosed pursuant to this authorization may be shared with your insurance payer during the appeal process. Once information is disclosed to the payer, it is subject to the payer's privacy practices, and federal HIPAA rules may no longer prevent the payer from re-disclosing the information.