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1. Authorization to Release Health Information

I authorize Cleo Care, LLC and its designated staff to contact my insurer and to request, receive, and discuss information regarding my insurance coverage and benefits for the purpose of verifying my eligibility. This may include my plan status, deductible and out-of-pocket amounts, copay and coinsurance details, coverage for specific services, and any prior authorization requirements. I may revoke this authorization at any time in writing.

2. Authorization for Claims Submission

I designate Cleo Care, LLC as my authorized agent for submitting health insurance claims on my behalf. All reimbursements are issued directly to me by my insurer. Cleo will not receive or redirect any funds. Cleo acts solely as a submission agent and is not an insurance company or claims adjudicator. I may revoke this authorization at any time in writing.