Terms of Service

1. Acceptance of Terms

By accessing or using ClaimSage ("the Service"), you agree to be bound by these Terms of Service. If you do not agree, do not use the Service. These Terms apply to all visitors, users, and others who access the Service.

2. Description of Service

ClaimSage is an AI-powered health insurance education platform. It includes:

• EOB Reader — analyzes Explanations of Benefits documents and extracts key claim data
• Appeal Letter Generator — drafts insurance appeal letters for denied or partially-covered claims
• Cost Estimator — provides estimated out-of-pocket costs for medical procedures based on plan type and location
• Benefits Navigator — explains insurance plan terms in plain English and compares plan types

These tools are educational and informational only. They are designed to help you understand your insurance documents and options — not to replace professional advice.

3. Not Legal, Medical, or Insurance Advice

ClaimSage does not provide legal advice, medical advice, or insurance advice. The output generated by our AI tools — including summaries, appeal letters, cost estimates, and coverage explanations — is for informational purposes only.

You should not rely solely on ClaimSage output when making healthcare decisions. Consult a licensed attorney, physician, or insurance professional for guidance specific to your situation.

4. No Guarantees

ClaimSage makes no guarantees regarding outcomes. Specifically:

• Appeal letters generated by ClaimSage may or may not result in a claim being overturned. Results depend on your insurer, plan terms, and circumstances.
• Cost estimates are approximations based on national benchmarks and regional data. Actual costs may differ materially from estimates.
• Coverage explanations reflect general plan structures and may not accurately describe the specific terms of your individual policy.
• AI-generated content may contain errors, omissions, or outdated information.

5. User Responsibilities

You are responsible for:

• Verifying the accuracy of all information generated by ClaimSage before acting on it
• Ensuring documents you upload or paste are accurate and belong to you or you have authorization to use
• All decisions made based on ClaimSage output, including whether to file an appeal or select a healthcare provider
• Complying with all applicable laws in your use of the Service
• Maintaining the confidentiality of any account credentials

Do not upload documents containing information about individuals other than yourself or those for whom you have legal authority to act.

6. Intellectual Property

ClaimSage owns all rights in the platform, including its software, design, AI models, and underlying technology. You may not copy, reproduce, or distribute any part of the platform without our written permission.

You retain ownership of documents you upload and content you generate using the Service (such as appeal letters). By using ClaimSage, you grant us a limited license to process your content for the purpose of delivering the Service.

7. Limitation of Liability

To the maximum extent permitted by law, ClaimSage and its operators shall not be liable for:

• Outcomes of insurance appeals, whether filed using ClaimSage-generated letters or otherwise
• Discrepancies between cost estimates and actual medical bills
• Coverage decisions made by your insurer based on ClaimSage output
• Any indirect, incidental, special, consequential, or punitive damages arising from your use of the Service
• Loss of data, revenue, or healthcare benefits resulting from reliance on ClaimSage output

In no event shall ClaimSage's aggregate liability to you exceed the amount you paid for the Service in the twelve months preceding the claim.

8. Data Handling

Your privacy matters. How we collect, store, and process your data is described in our Privacy Policy. By using ClaimSage, you also agree to the practices described there.

Documents you upload (such as EOB images) may be processed by AI models to deliver the Service. We do not sell your health information to third parties.

9. Modifications to Terms

ClaimSage reserves the right to modify these Terms at any time. We will update the effective date above when changes are made. Your continued use of the Service after any modification constitutes your acceptance of the updated Terms.

If we make material changes, we will make reasonable efforts to notify you — for example, by displaying a notice on the platform.

10. Termination

Either you or ClaimSage may terminate your access to the Service at any time. You may stop using ClaimSage at any time. We reserve the right to suspend or terminate your access if you violate these Terms.

Upon termination, your right to use the Service ceases immediately. Data handling after termination is described in our Privacy Policy.

11. Governing Law

These Terms shall be governed by and construed in accordance with the laws of the State of California, without regard to its conflict of law provisions. Any disputes arising under these Terms shall be resolved in the courts of California.

12. Contact

Questions about these Terms? Contact us at claimsage@polsia.app.