Services Policy
Effective Date: 3/28/26
Last Updated: 4/1/26
1. Overview
This Services Policy describes the terms and conditions under which Revolution Health Alliance, PLLC, doing business as Midlife Metabolic Medicine (“MMM,” “we,” “our,” or “us”) provides clinical services to patients. By scheduling an appointment, enrolling in a program, or otherwise engaging our clinical services, you agree to the terms described in this policy.
Midlife Metabolic Medicine is a telehealth nurse practitioner practice providing metabolic weight management and hormonal medicine services. All clinical services are delivered via telehealth pursuant to Idaho’s Virtual Care Access Act (I.C. § 54-5703 et seq.) and applicable Oregon telehealth statutes. Clinical services are provided to patients located in Idaho and Oregon by Denise Erland, FNP-C, FMACP.
2. Scope of Services
MMM provides clinical care focused on metabolic weight management, hormonal medicine, and related conditions including insulin resistance, prediabetes, type 2 diabetes, high cholesterol, high blood pressure, hypothyroidism, and perimenopausal hormonal dysfunction. Our services include clinical evaluation, individualized treatment planning, medication management (including GLP-1 receptor agonists, metformin, bioidentical hormone replacement therapy, and thyroid medications), clinical nutrition prescriptions, exercise prescriptions, continuous glucose monitoring, remote patient monitoring, and ongoing metabolic and hormonal stewardship.
MMM does not provide emergency medical services, primary care for conditions unrelated to metabolic and hormonal health, mental health counseling or psychotherapy, surgical services, or care for patients outside of Idaho and Oregon. If you are experiencing a medical emergency, call 911 or go to your nearest emergency department.
3. Licensure and Geographic Requirements
Clinical services are provided to patients located in Idaho and Oregon. You must be physically located in one of these states at the time of each telehealth visit. If you relocate permanently to a state in which we do not provide clinical services, we will assist with a transition plan and provide clinical records to your new provider, but we will not be able to continue providing clinical care.
If you travel or split time between states, you must be physically located in Idaho or Oregon at the time of each scheduled visit. If an extended absence from both states is anticipated, discuss scheduling accommodations with your provider in advance.
4. Services and Pricing
4.1 Discovery Visit
A no-charge 15-minute introductory telehealth conversation to answer your questions, determine clinical fit, and outline next steps. The Discovery Visit is not a clinical evaluation and does not establish a provider-patient relationship for treatment purposes. No fee is charged.
4.2 Metabolic Evaluation
A comprehensive diagnostic evaluation consisting of a 60-minute intake appointment, a comprehensive laboratory assessment tailored to your metabolic and hormonal profile (including a full hormonal panel), and a 45-minute review of findings with specific clinical recommendations. The Metabolic Evaluation fee is $595. Laboratory costs are separate and are not included in this fee (typical range: $300–$500 for the initial panel). The timeline for the Metabolic Evaluation is 2–4 weeks depending on laboratory turnaround. The $595 evaluation fee is credited in full toward enrollment in the Metabolic Rebuild if you choose to enroll.
4.3 Metabolic Rebuild
A 4-month structured clinical program. The Metabolic Rebuild fee is $6,495 as a one-time payment, or $1,725 per month for four months ($6,900 total) under the monthly payment plan. The program includes 8 biweekly clinical visits (2 onboarding sessions at 45 minutes each, 6 follow-up visits at 30 minutes each), HIPAA-compliant messaging access with 48-hour business response, drop-in provider access during open office hours twice per week, medication management (including bioidentical hormone replacement therapy when clinically indicated), an individualized nutrition protocol, an individualized exercise protocol, a clinical monitoring kit (provided at enrollment, approximately $670 value, absorbed into program price), two continuous glucose monitoring windows with provider analysis, repeat laboratory assessment at 12 weeks (lab costs separate), 12-week access to an asynchronous educational course, individualized supplement recommendations if indicated with 15% supplement discount, and 15% discount on additional diagnostic testing. Bioidentical hormone replacement therapy medication cost is separate from the program fee and billed by MMM (see Section 10).
4.4 Active Continuity
Ongoing structured care for patients whose metabolic and hormonal picture is still actively evolving after completing the Metabolic Rebuild. The fee is $425 per month, billed monthly. Active Continuity includes 6 one-hour clinical visits per year (bimonthly cadence), continued messaging access and open office hours, ongoing medication management (including bioidentical hormone replacement therapy management), quarterly lab reassessments as indicated (lab costs separate), quarterly nutrition and exercise protocol recalibration, one 4-week CGM monitoring block per year with provider analysis (sensor cost included), curated recipe library access, and 15% supplement and lab discounts. Bioidentical hormone replacement therapy medication cost is separate from the monthly membership fee and billed by MMM (see Section 10). Active Continuity is month-to-month with 30 days’ written notice required to discontinue.
4.5 Continuity Care
Long-term metabolic and hormonal stewardship for stabilized patients. The fee is $250 per month, billed monthly. Continuity Care includes 3 one-hour clinical visits per year, continued messaging access and open office hours, medication management at each visit (including ongoing bioidentical hormone replacement therapy management), annual comprehensive lab reassessment (lab costs separate), annual supplement review if indicated, CGM monitoring as clinically recommended (sensor cost patient-borne, approximately $55 per 2-week sensor), curated recipe library access, and 15% supplement and lab discounts. Bioidentical hormone replacement therapy medication cost is separate from the monthly membership fee and billed by MMM (see Section 10). Continuity Care is month-to-month with 30 days’ written notice required to discontinue.
4.6 Combined Membership Cap
Active Continuity and Continuity Care share a combined cap of 40 members. The Metabolic Rebuild is limited to 8 new patients per month. These caps are in place to preserve the depth and quality of the clinical relationship.
5. Payment Terms
All payments are processed through Stripe. We accept major credit cards, debit cards, and ACH transfers where supported by Stripe. Payment is due at the time of service or at the beginning of each billing cycle for monthly memberships and payment plans.
5.1 Insurance
Midlife Metabolic Medicine is not an insurance-based practice. We do not bill insurance or accept insurance assignment. Operating outside of insurance allows us to determine visit length, visit frequency, diagnostic scope, and intervention selection based solely on your clinical needs. We provide superbills for all services, which you may submit to your insurance company to seek out-of-network reimbursement. Reimbursement rates and eligibility vary by plan. Providing the superbill is the extent of our participation in the reimbursement process; we are not able to engage in disputes or advocacy with insurance carriers on your behalf.
5.2 HSA and FSA
All services at Midlife Metabolic Medicine are eligible for payment through Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA).
5.3 Laboratory Costs
Laboratory work is ordered separately through our clinical laboratory partner and is not included in the Metabolic Evaluation or Metabolic Rebuild fee. The initial lab panel typically costs $300–$500 depending on the specific tests your metabolic and hormonal profile requires. Repeat labs at 12 weeks typically cost $140–$250. You receive a 15% discount on all laboratory testing ordered through our clinical laboratory partner.
5.4 Late and Failed Payments
If a scheduled payment fails, we will attempt to process the payment again and notify you via your patient portal. If payment is not resolved within 14 days, clinical services may be paused until the balance is current. Persistent non-payment may result in discontinuation of services. We will provide 30 days’ notice before any service interruption and will not withhold access to your medical records due to an outstanding balance.
6. Refund Policy
6.1 Metabolic Evaluation
The Metabolic Evaluation fee ($595) is non-refundable once the intake appointment has been completed. If you cancel before the intake appointment, a full refund will be issued.
6.2 Metabolic Rebuild
The refund policy for the Metabolic Rebuild is structured in three tiers:
• Before monitoring kit shipment: Full refund minus a $250 administrative fee. This fee reflects estimated actual costs incurred at the time of enrollment, including clinical intake processing, electronic health record setup, care plan development, and administrative coordination. It is not a penalty for cancellation.
• After kit shipment but within the first 30 days: Prorated refund minus the cost of the monitoring kit (approximately $670). You keep the kit.
• After 30 days: The program is non-refundable.
If you are on the monthly payment plan, any refund is calculated against payments made to date. Remaining installments are cancelled upon approved discontinuation.
6.3 Active Continuity and Continuity Care
Both continuity tiers are month-to-month. No refunds are issued for partial months. To discontinue, provide 30 days’ written notice via your patient portal or email to denise@midlifemetabolicmedicine.com. Your final billing cycle will be the 30-day period following receipt of your notice.
6.4 Evaluation Credit
The $595 Metabolic Evaluation fee is credited in full toward the Metabolic Rebuild if you enroll. This credit is applied at the time of Rebuild enrollment. If you do not enroll in the Metabolic Rebuild, the Evaluation fee is not refundable (the clinical services have been rendered).
6.5 Provider-Initiated Termination
If the provider initiates termination of the clinical relationship during the Metabolic Rebuild (due to clinical safety concerns, development of a contraindication, loss of licensure in the patient’s state, or other circumstances in which the practice can no longer safely provide care), you will receive a prorated refund of the Metabolic Rebuild fee based on the proportion of the program remaining, minus the cost of the monitoring kit if already shipped. You keep the monitoring kit. For continuity memberships, provider-initiated termination follows the same 30-day notice period as patient-initiated termination. Active prescriptions will be managed through the transition period as described in Section 11.
7. Program Pause Policy
The Metabolic Rebuild allows for one pause of up to 30 days during the program in the event of a medical issue, family emergency, or other significant life event. A pause extends your program end date by the length of the pause. Pauses do not affect your payment schedule for one-time payments. For monthly payment plans, payments continue during a pause unless otherwise agreed in writing. Please discuss any anticipated disruptions with your provider as early as possible.
Active Continuity and Continuity Care do not have a formal pause policy. If you need to temporarily suspend services, provide written notice. Billing will continue until 30 days after receipt of your discontinuation notice. You may re-enroll at any time, subject to membership cap availability.
8. Clinical Monitoring Kit
Upon enrollment in the Metabolic Rebuild, you receive a clinical monitoring kit containing a Withings Body Comp scale, a Withings BPM Connect blood pressure cuff, a Withings ScanWatch 2, and a Dexcom Stelo 2-pack (or Dexcom G7 prescription if clinically indicated). The cost of this kit (approximately $670) is absorbed into the Metabolic Rebuild program fee.
8.1 Ownership
The monitoring devices are yours to keep permanently, regardless of whether you continue care with this practice. Ownership transfers to you at the time of shipment.
8.2 Returns
Because the monitoring devices are personal health devices that are configured to your accounts and in contact with your body, they are non-returnable once shipped. If you discontinue the Metabolic Rebuild after the kit has shipped, the kit cost (approximately $670) is deducted from any refund as described in Section 6.2.
8.3 Replacement
If a device is defective or malfunctions within the manufacturer’s warranty period, we will assist you in obtaining a replacement through the manufacturer. Replacement of lost, stolen, or damaged devices beyond the warranty period is your responsibility.
9. Telehealth Informed Consent
All clinical services are delivered via telehealth. Prior to your first clinical visit, you will be asked to provide informed consent to receive services via telehealth. This consent covers the delivery method, the security measures in place to protect your health information, the potential for information loss due to technical failures, your right to discontinue telehealth at any time and request an alternative (in-person) referral, and the limitations inherent in telehealth. Informed consent is obtained and documented through Practice Better in compliance with Idaho’s Virtual Care Access Act (IDAPA 24.33.03.205) and Oregon telehealth consent requirements.
If you indicate at any point that you wish to stop using telehealth, the service will cease, and we will assist you in finding an appropriate in-person provider if available.
10. Medication and Prescribing
Medications, including GLP-1 receptor agonists (semaglutide, tirzepatide), metformin, bioidentical hormone replacement therapy, and thyroid medications, are prescribed only when clinically indicated based on your laboratory results, metabolic profile, and clinical history. We do not guarantee that any specific medication will be prescribed. All prescriptions are transmitted electronically through DrFirst.
Our provider holds full independent prescriptive authority in both Idaho and Oregon, including authority to prescribe legend drugs and controlled substances in Schedules II through V, with active DEA registration. Idaho grants NPs full independent practice and prescriptive authority under Idaho Admin. Code §24.34.01. Oregon similarly authorizes NPs to prescribe legend drugs and Schedules II–V controlled substances under ORS 678.390 and OAR 851-056. No physician supervision or collaborative agreement is required in either state.
All controlled substance prescribing complies with applicable federal DEA regulations, Idaho Board of Pharmacy requirements, and Oregon Board of Pharmacy requirements, including Prescription Drug Monitoring Program (PDMP) obligations. Oregon requires PDMP checks prior to prescribing Schedule II–IV controlled substances and at least every 90 days for ongoing prescriptions (ORS 435.405); this is a universal prescribing requirement, not a telehealth-specific restriction.
Neither Idaho nor Oregon imposes a state-level telehealth-specific restriction on controlled substance prescribing beyond federal law. Idaho Code § 54-5706 permits controlled substance prescribing via telehealth in compliance with 21 U.S.C. § 802(54)(A), deferring to the federal standard. Oregon similarly permits Schedule II–V prescribing via telehealth provided a valid provider-patient relationship is established and an appropriate medical evaluation has been conducted. Neither state requires an initial in-person visit before prescribing controlled substances via telehealth. At the federal level, DEA telemedicine flexibilities permitting Schedule II–V prescribing without an initial in-person examination have been extended through December 31, 2026. When a permanent federal rule replaces these flexibilities, both states will operate under the updated federal standard.
Medication costs are your responsibility. For most medications, prescriptions are sent electronically to the pharmacy of your choice and filled through your pharmacy’s standard process. MMM does not dispense these medications directly. We do not guarantee insurance coverage, prior authorization approval, or availability of any specific medication. The exception is compounded bioidentical hormone replacement therapy (BHRT). BHRT medications are sourced from a rigorously vetted, quality-certified compounding pharmacy and billed through our practice, so you have one billing relationship with MMM for your hormonal medication. BHRT medication cost is separate from program and membership fees and varies based on your individualized prescription and formulation.
11. Provider-Patient Relationship
The provider-patient relationship is established at the time of the Metabolic Evaluation intake appointment, not at the Discovery Visit. The Discovery Visit is an introductory conversation only and does not constitute a clinical evaluation, diagnosis, or treatment.
MMM is a solo provider practice. Your care is delivered by Denise Erland, FNP-C, FMACP. In the event that the provider is temporarily unavailable (illness, vacation, personal leave), scheduled visits will be rescheduled and messaging response times may be extended. MMM does not provide coverage by a substitute provider during temporary absences. For patients on active medication regimens (including GLP-1 receptor agonists, bioidentical hormone replacement therapy, and thyroid medications), the provider will ensure that prescriptions are current and sufficient to cover the anticipated absence period before the absence begins. If an unanticipated absence extends beyond 14 days, patients on active medications will be contacted with instructions for obtaining interim prescriptions through their primary care provider or an urgent care facility. In the event of a medical emergency while your provider is unavailable, contact 911 or your nearest emergency department.
Either party may terminate the provider-patient relationship. If the provider determines that the practice is no longer able to meet your clinical needs, we will provide a minimum of 30 days’ written notice and assist with transition to another provider, including providing your medical records and, for patients on active medication regimens, ensuring that prescriptions are sufficient to cover the transition period or facilitating transfer of prescribing responsibility to your primary care provider or a receiving provider. Patient-initiated termination follows the discontinuation and refund procedures described in Sections 6 and 7. Financial remedies for provider-initiated termination during the Metabolic Rebuild are described in Section 6.5.
In the event that the provider becomes permanently unable to practice (due to death, permanent disability, loss of licensure, or practice closure), the practice will make reasonable efforts to notify all active patients, facilitate transfer of medical records to each patient’s designated provider, and issue prorated refunds for any pre-paid program fees for services not yet rendered. The provider has designated a clinical colleague to facilitate patient record transfers and care transitions in such circumstances. Active patients’ medical records will be retained and made available in accordance with Idaho and Oregon medical record retention requirements. Neither Idaho statute nor Idaho Board of Nursing rules, nor Oregon statute nor Oregon Board of Nursing rules, mandate a formal written succession plan for a solo healthcare practice. However, patient abandonment standards in both states require that patients not be left without reasonable notice and opportunity to secure alternative care. A designated clinical colleague arrangement — documented in a written agreement with the colleague’s consent, addressing record access, patient notification, medication continuity, and refund processing authority — meets the standard of care for a prudent solo practitioner in both jurisdictions, even though it is not statutorily required. Oregon SB 951 (2025), which addresses succession agreements for physician practices with MSO affiliations, does not apply to solo NP PLLCs without MSO relationships.
12. Standard of Care and Limitations
All services are provided in accordance with the applicable standard of care for nurse practitioner practice in Idaho and Oregon, as required by the Idaho Virtual Care Access Act and Oregon telehealth regulations. Telehealth services are held to the same standard of care as in-person services.
MMM does not guarantee specific health outcomes, including specific amounts of weight loss, specific lab result changes, or resolution of any medical condition. Individual results vary based on adherence, genetics, comorbid conditions, medication response, and other factors outside the provider’s control. The care we provide is evidence-informed and individually tailored, but no outcome is guaranteed.
13. Communication
All clinical communication occurs through your HIPAA-compliant patient portal in Practice Better. We do not conduct clinical communication via standard email, text message, or social media. Our guaranteed messaging response time is 48 business hours. Open office hours are available twice per week for drop-in provider access during the Metabolic Rebuild and continuity tiers.
Marketing communications (email newsletters, educational content, webinar invitations) are sent through HubSpot and are separate from clinical communications. You may opt out of marketing communications at any time without affecting your clinical care.
14. Medical Records
Your medical records are maintained in Practice Better. You have the right to access and obtain a copy of your medical records at any time. Records requests should be directed to denise@midlifemetabolicmedicine.com. Medical records are retained in accordance with Idaho and Oregon state medical record retention requirements. We will not withhold access to your medical records due to an outstanding account balance.
15. Governing Law and Dispute Resolution
This Services Policy is governed by the laws of the State of Idaho.
15.1 Mediation
Before initiating any legal proceeding arising out of or relating to services provided under this policy, the parties agree to attempt resolution through good-faith mediation. Either party may initiate mediation by providing written notice to the other party. The parties will mutually select a mediator within 30 days of the notice. Mediation costs will be shared equally. Mediation is a prerequisite to filing any court action, except in cases requiring emergency or injunctive relief.
15.2 Jurisdiction and Venue
If mediation does not resolve the dispute, either party may pursue the matter in court. For disputes involving patients located in Idaho at the time of the disputed services, or for any non-clinical dispute (including billing, refund, or policy interpretation disputes regardless of patient location), venue shall be in the state or federal courts of Ada County, Idaho. For disputes involving clinical care claims by patients located in Oregon at the time of the disputed services, venue shall be in the state or federal courts of the State of Oregon in the county where the patient was located at the time of the disputed services, applying Oregon law to the clinical care claims.
15.3 Professional Liability
Nothing in this Section limits or modifies the terms of any professional liability or malpractice insurance policy covering the provider. In the event of any conflict between this dispute resolution clause and the requirements of the provider’s professional liability carrier, the carrier’s requirements shall govern.
15.4 Acknowledgment
By enrolling in any clinical program or membership, you acknowledge that you have read and understand this dispute resolution provision. This provision is intended to be separate from, and independently enforceable from, the remainder of this Services Policy.
16. Changes to This Services Policy
We may update this Services Policy from time to time to reflect changes in our services, pricing, legal requirements, or operational procedures. When we make material changes, we will update the “Last Updated” date at the top of this page and notify active patients through the patient portal. Material changes to pricing or refund terms will not apply retroactively to patients currently enrolled in a program or membership at the time of the change.
17. Contact Information
If you have questions about this Services Policy, please contact us:
Denise Erland, FNP-C, FMACP
Midlife Metabolic Medicine, 1350 S Five Mile Rd, Unit 190544, Boise, ID 83719