CASH-PAY FINANCIAL POLICY

VitalCare Health (“VitalCare,” “we,” “us,” or “our”) provides healthcare services on a cash-pay basis, including both in-person and telehealth services. This Cash-Pay Financial Policy (“Policy”) explains our fees, payment requirements, cancellations, refunds, and other financial arrangements associated with receiving services from VitalCare Health.

Our goal is to ensure that our financial arrangements are clear, transparent, and easy to understand before you receive care.

By scheduling or receiving services from VitalCare Health, you acknowledge that you have had an opportunity to review this Policy and agree to its applicable terms.

1. CASH-PAY MODEL

VitalCare Health operates as a cash-pay healthcare provider.

This means:

Patients pay VitalCare Health directly for services.
We do not submit claims to health insurance companies on behalf of patients.
Patients are responsible for understanding and paying our applicable fees.
Payment is required regardless of whether a patient’s insurance plan would have covered or reimbursed the service.
We do not guarantee that an insurance company will reimburse a patient for services obtained from VitalCare Health.

Our cash-pay model applies to both in-person and telehealth services, unless otherwise stated.

2. SERVICES COVERED BY THIS POLICY

This Policy may apply to services including:

Initial in-person consultations;
Follow-up in-person consultations;
Initial telehealth consultations;
Follow-up telehealth consultations;
Healthcare evaluations;
Medication-related consultations;
Prescription-related services where clinically appropriate;
Care coordination;
Follow-up communications;
Other healthcare services offered by VitalCare Health.

The specific services and applicable fees will be communicated to you before or during scheduling, registration, or purchase.

3. FEES AND PRICING

VitalCare Health will communicate applicable fees before you receive a service whenever reasonably practicable.

Fees may vary depending on:

Type of service;
Length of consultation;
Whether the service is provided in person or through telehealth;
Complexity of the service;
Additional services requested or clinically required; and
Other applicable factors.

The fee quoted for an appointment applies to the service specified at the time of scheduling.

Payment for an appointment does not guarantee a particular diagnosis, prescription, treatment, referral, or medical outcome.

4. PAYMENT REQUIREMENTS

Payment may be required:

At the time of scheduling;
Before an appointment;
At the time of an in-person appointment;
At the beginning or end of a telehealth appointment;
After a service has been provided; or
According to the payment terms communicated when the service is scheduled.

VitalCare Health may require payment before providing certain services.

We reserve the right to decline or postpone non-emergency services when required payment has not been received, subject to applicable law and professional obligations.

5. ACCEPTED PAYMENT METHODS

VitalCare Health may accept payment through methods made available by the practice, which may include:

Credit cards;
Debit cards;
Electronic payments;
Online payment systems;
Patient portal payments; and
Other payment methods approved by VitalCare Health.

Payment methods may vary between in-person and telehealth services.

6. CREDIT AND DEBIT CARD AUTHORIZATION

Where you provide a credit or debit card for payment, you authorize VitalCare Health to charge the card for:

Agreed healthcare services;
Applicable cancellation fees;
No-show fees;
Other disclosed administrative charges; and
Outstanding balances that you have authorized or are otherwise legally obligated to pay.

We will not intentionally charge amounts that have not been disclosed or authorized, except where otherwise permitted by law.

7. INSURANCE

VitalCare Health is a cash-pay practice and does not routinely submit claims to insurance companies.

You are responsible for:

Paying VitalCare Health directly;
Determining whether your insurance plan provides out-of-network reimbursement;
Understanding your insurance plan’s requirements;
Submitting documentation to your insurer when necessary; and
Following up directly with your insurance company regarding reimbursement.

VitalCare Health cannot guarantee insurance reimbursement.

8. SUPERBILLS AND RECEIPTS

Upon request, VitalCare Health may provide a receipt or superbill containing information necessary for you to submit a reimbursement request to your insurance company.

A superbill does not constitute an insurance claim submitted by VitalCare Health.

Providing a superbill does not guarantee reimbursement.

You are responsible for verifying:

Whether your insurance plan covers the service;
Whether the provider is eligible for reimbursement;
Applicable deductibles and coinsurance;
Out-of-network requirements; and
Any documentation required by your insurance company.

9. ESTIMATES AND FINANCIAL TRANSPARENCY

When reasonably practicable, we will provide information about expected charges before services are provided.

Healthcare needs can change during an appointment, and additional services may sometimes become clinically appropriate.

Where additional charges may apply, we will communicate them to you when reasonably practicable before providing the additional service.

An estimate is not necessarily a guarantee of the final amount owed.

10. CANCELLATION POLICY

We understand that circumstances may change.

If you need to cancel an appointment, please notify us as soon as possible.

Cancellation 24 Hours or More Before the Appointment

When you cancel at least 24 hours before your scheduled appointment:

No late cancellation fee will generally apply.
If you prepaid, you may generally request a refund or have the payment applied toward a future appointment.

Cancellation Less Than 24 Hours Before the Appointment

A cancellation made less than 24 hours before the scheduled appointment may result in a $20 late cancellation fee.

Same-Day Cancellation

A same-day cancellation may be treated as a late cancellation and may be subject to the applicable fee.

These provisions apply to both in-person and telehealth appointments.

11. MISSED APPOINTMENTS / NO-SHOWS

A no-show occurs when a patient fails to attend a scheduled appointment without providing appropriate notice.

This may include:

Failing to attend an in-person appointment;
Failing to join a telehealth appointment;
Being unavailable when the provider attempts to begin a telehealth consultation;
Failing to respond to reasonable attempts to establish a telehealth connection; or
Arriving too late for the appointment to reasonably proceed.

A $50 no-show fee may apply.

Repeated no-shows may result in restrictions on future scheduling where permitted by law.

12. LATE ARRIVALS

In-Person Appointments

Patients are expected to arrive on time.

Arriving late may reduce the time available for your appointment.

If you arrive more than 10 minutes late, your appointment may be treated as a late arrival or no-show depending on the circumstances.

Telehealth Appointments

Patients should join the telehealth appointment at the scheduled time.

If you join more than 10 minutes late, the appointment may be considered a late arrival or no-show depending on the circumstances.

The provider may be unable to extend the appointment beyond the scheduled end time.

13. RESCHEDULING

Patients may request to reschedule an appointment by contacting VitalCare Health.

When sufficient notice is provided, we will generally attempt to transfer the appointment to another available date and time without an additional fee.

Rescheduling remains subject to provider availability.

Repeated rescheduling may result in reasonable scheduling restrictions.

14. TELEHEALTH TECHNICAL PROBLEMS

Telehealth services depend on technology, internet connectivity, devices, and third-party platforms.

If a technical problem prevents the consultation from being completed, VitalCare Health may:

Attempt to reconnect;
Use another approved communication method;
Reschedule the appointment;
Convert the visit to an in-person appointment where clinically appropriate; or
Provide a refund or credit where appropriate.

VitalCare Health will generally not impose a cancellation or no-show fee solely because of a technical problem attributable to our systems.

Where a technical problem is caused by the patient’s equipment, internet connection, or inability to access the telehealth platform, the applicable circumstances will be reviewed individually.

15. REFUNDS

Refunds are considered according to the circumstances of the transaction and this Policy.

A refund may be available when:

An appointment is cancelled within the permitted cancellation period;
VitalCare Health cancels an appointment and cannot provide a suitable alternative;
A service cannot reasonably be provided;
A payment was made in error; or
A refund is otherwise required by applicable law.

Where applicable, cancellation or no-show fees may be deducted before a refund is issued.

16. REFUND METHOD AND PROCESSING TIME

Approved refunds will generally be issued using the same payment method used for the original transaction, unless otherwise agreed or required by law.

Refunds will generally be initiated within 5–10 business days after approval.

The time required for the refund to appear in your account may depend on your bank, credit card company, or payment processor.

VitalCare Health is not responsible for delays caused solely by third-party financial institutions.

17. NON-REFUNDABLE SERVICES

Certain services, administrative fees, packages, or promotional offers may be designated as non-refundable.

Any applicable non-refundable terms will be clearly disclosed before purchase.

A charge will not be treated as non-refundable unless the applicable restriction has been properly disclosed to the patient.

18. PREPAID SERVICES AND PACKAGES

If VitalCare Health offers prepaid packages, memberships, subscriptions, or multiple-visit arrangements, separate terms may apply.

The applicable terms may specify:

Services included;
Total price;
Payment schedule;
Expiration date;
Cancellation requirements;
Refund eligibility; and
Other applicable conditions.

Unused services will be handled according to the applicable package terms and applicable law.

19. PROVIDER CANCELLATION

VitalCare Health may occasionally need to cancel or reschedule an appointment because of:

Provider illness;
Emergency circumstances;
Technical problems;
Unexpected clinical circumstances;
Staffing issues;
Safety concerns; or
Circumstances beyond our reasonable control.

If we cancel your appointment and cannot provide a reasonable alternative, you may generally choose to:

Reschedule; or
Receive a refund for the affected prepaid service.

Patients will not be charged a cancellation fee when VitalCare Health cancels an appointment.

20. CLINICAL DETERMINATIONS AND PAYMENT

Payment for an appointment does not guarantee that a provider will:

Prescribe a specific medication;
Provide a particular treatment;
Make a particular diagnosis;
Provide a referral;
Order a specific test; or
Approve a patient’s requested service.

Clinical decisions are based on professional judgment, applicable law, patient circumstances, and appropriate standards of care.

If a provider determines that a requested service is not clinically appropriate, the provider may decline to provide it.

21. WHEN TELEHEALTH IS NOT APPROPRIATE

A telehealth appointment may not be appropriate for every healthcare concern.

A provider may determine that an in-person examination or other evaluation is necessary.

In such circumstances, VitalCare Health may recommend:

An in-person appointment;
Laboratory testing;
Diagnostic imaging;
Specialist consultation;
Another healthcare facility; or
Emergency care.

Any refund or credit resulting from a change in the method of care will be determined based on the circumstances and applicable policy.

22. ADDITIONAL SERVICES

Certain services may involve additional costs.

Examples may include:

Laboratory services;
Diagnostic testing;
External specialist services;
Medical records requests where legally permitted;
Certain administrative services; or
Services provided by third parties.

Where such charges are not included in the standard VitalCare Health fee, patients may be responsible for paying them separately.

We will communicate additional charges when reasonably practicable.

23. MEDICAL RECORDS AND ADMINISTRATIVE FEES

Certain requests for copies, certifications, forms, administrative services, or records may be subject to fees where permitted by applicable law.

Any applicable fee will be communicated before the service is completed when reasonably practicable.

We will comply with applicable federal and Minnesota requirements governing access to and copies of health records.

24. OUTSTANDING BALANCES

Patients are responsible for paying outstanding balances when due.

If an account remains unpaid, VitalCare Health may:

Contact you regarding the balance;
Provide payment reminders;
Request payment before future non-emergency services;
Limit future scheduling where permitted by law; or
Take other lawful collection measures.

We will not take action that would improperly interfere with a patient’s access to legally required emergency or other protected healthcare services.

25. PAYMENT DISPUTES

If you believe that you have been charged incorrectly, please contact us promptly.

We encourage patients to contact VitalCare Health before initiating a payment dispute or chargeback so that we have an opportunity to investigate and resolve the matter.

Nothing in this Policy limits your legal rights concerning unauthorized transactions or other rights that cannot legally be waived.

26. FINANCIAL HARDSHIP

VitalCare Health understands that unexpected financial circumstances may occur.

If you are experiencing difficulty paying for services, you may contact us to discuss whether an alternative payment arrangement is available.

Any payment arrangement is subject to approval and does not guarantee that a discount, payment plan, or fee waiver will be provided.

27. EMERGENCY SERVICES

This Financial Policy must never be interpreted as preventing you from seeking emergency medical care.

If you are experiencing a medical emergency, call 911 or go to the nearest emergency department immediately.

Do not delay emergency treatment because of concerns about payment, insurance, refunds, or appointment fees.

28. PRIVACY OF FINANCIAL INFORMATION

Payment and billing information will be handled in accordance with applicable privacy and security requirements.

Where payment information is processed through third-party payment platforms, those platforms may have their own terms and privacy policies.

Protected health information will be handled in accordance with VitalCare Health’s Notice of Privacy Practices and applicable law.

29. CHANGES TO THIS POLICY

VitalCare Health may update this Financial Policy from time to time to reflect changes in:

Services;
Fees;
Payment processes;
Technology;
Business practices; or
Applicable laws and regulations.

The current version will be made available to patients and will include the applicable Effective Date and Last Updated date.

30. CONTACT US

If you have questions about fees, payments, refunds, cancellations, or other financial matters, please contact:

VITALCARE HEALTH

Address:
2600 East 25th Street, Upstairs Suite
Minneapolis, MN 55406

Telephone: +1 (612) 633-7898
Email: info@vitalcarehealth.org
Website: www.vitalcarehealth.org

PATIENT ACKNOWLEDGMENT

By scheduling or receiving services from VitalCare Health, I acknowledge that:

I understand VitalCare Health operates on a cash-pay basis.
I understand that VitalCare Health does not submit claims to my health insurance company.
I am responsible for applicable fees for services I receive.
I understand the cancellation, rescheduling, no-show, and refund provisions described in this Policy.
I understand that payment does not guarantee a particular diagnosis, prescription, treatment, referral, or medical outcome.
I understand that the Policy applies to both in-person and telehealth services.
I have had an opportunity to ask questions about the financial terms applicable to my care.

Patient Name: ___________________________________

Signature: ______________________________________

Date: ___________________________________________

Parent/Guardian/Authorized Representative (if applicable):

Signature: ______________________________________

Date: ___________________________________________