Payment, Refund, No-Show, and Billing Policy

Sky e-Clinic operates on a cash-pay model. A valid payment card is required at booking, but the consultation fee is not charged at booking and is not charged before the visit unless a separate fee is expressly disclosed and authorized.

After the clinician completes the encounter and required documentation, the selected consultation fee is charged to the card on file through Elation Patient Payments / Stripe. The fee pays for clinical review, evaluation, judgment, documentation, and a clinical decision or visit summary. It is not a prescription fee and does not guarantee a prescription, lab order, note, referral, or specific outcome.

Standard self-pay consultation range: $50-$300 depending on visit type, modality, duration, and clinical workflow. The specific selected fee is shown before booking and again in the booking confirmation; that selected fee is the patient-specific estimate for the scheduled Sky service.

For uninsured and self-pay patients, Sky provides the GFE through a practical scheduling-time packet: the selected fee displayed before booking, the booking confirmation / Patient Passport notification, and the bilingual standing Good Faith Estimate Notice. Sky does not rely on staff to manually create a separate GFE document for every routine visit.

If a patient requests a written copy or the automated confirmation fails to show the required fields, billing staff should issue a written GFE copy through Patient Passport or another approved secure channel.

• Medication — Medication costs are paid to the pharmacy unless specifically listed.
• Laboratory — Lab fees are paid to the laboratory unless a different approved workflow is posted.
• Outside care — Imaging, urgent care, emergency care, specialists, outside facilities, and outside clinicians are separate.
• Insurance reimbursement — A superbill may be provided upon request, but reimbursement is not guaranteed.

Refund decisions are based on two practical questions: whether a charge has already been processed, and whether Sky has already provided meaningful clinician review, risk assessment, evaluation, documentation, care instructions, referral guidance, or another clinical decision.

• Cancellation effective time — A cancellation or rescheduling request is effective only when Sky receives a clear request identifying the patient and appointment through Patient Passport/self-service, live phone confirmation, or identifiable voicemail. A missed call, no-message call, or unclear message is not a cancellation.
• Cancellation before any charge — If the visit is cancelled before any charge has been processed and before meaningful clinician review has begun, Sky does not charge the consultation fee; no refund is needed.
• Fee change or added service declined before review — If a chat-to-video conversion, same-encounter add-on, or other fee change is proposed and the patient declines before meaningful clinician review, risk assessment, evaluation, or other clinical service has occurred, Sky uses the no-charge pathway, or a full refund if a charge was already processed.
• No meaningful care provided — If Sky cannot provide clinically meaningful care and no meaningful clinician review, risk assessment, evaluation, documentation, care instruction, referral guidance, or clinical decision has occurred, Sky does not charge, or refunds the charge if already processed.
• Clinic-side failure — Platform outage, clinician non-response beyond the published timeframe, or substantiated inappropriate conduct may result in a refund or no-cost rescheduling.
• Late cancellation or no-show — If the patient cancels late, does not attend a scheduled video visit, or does not respond after the booked time once the physician has begun meaningful review, Sky may charge or retain the disclosed fee if permitted by posted policy and applicable law.
• Meaningful clinician work completed — After meaningful clinician review, risk assessment, evaluation, documentation, care instructions, referral guidance, or another clinical decision has occurred, the consultation fee is generally non-refundable, even if no prescription, lab order, document, or specific outcome is provided.
• Outside scope or jurisdiction — Sky may waive or refund the fee if Sky cannot proceed and the patient did not knowingly bypass screening. If the patient knowingly provides false or misleading screening information and meaningful clinician work has occurred, the fee may be retained.

Patients should contact billing@skyeclinic.org or Patient Passport support before initiating a chargeback. In payment disputes, Sky submits only minimum-necessary non-clinical billing facts unless legal review authorizes otherwise.

• Billing — billing@skyeclinic.org
• General support — support@skyeclinic.org
• Clinical communication — Patient Passport only
• Mail — SKY E-CLINIC LLC, 1164 Bishop St STE 940, Honolulu, HI 96813

A chat/asynchronous visit may be converted to video when the physician determines that video is needed. If conversion or a same-encounter added service changes the expected Sky charge, Sky discloses the updated fee before the card is charged and records the patient's agreement through a Patient Passport written confirmation/notification, updated booking/payment record, and chart note. During a live synchronous encounter, the physician may also explain the changed fee verbally, but the durable record is the Patient Passport/booking/payment record plus chart documentation before charging. If the patient does not agree before meaningful chart review, risk assessment, evaluation, or other clinical service has occurred, Sky uses the no-clinically-meaningful-care pathway: no charge if the card has not yet been charged, or full refund if a charge was already processed. If meaningful clinician review, risk assessment, documentation, or a clinical decision has already occurred, the fee may be retained. Sky's standard consultation range remains $50-$300 unless the price table is republished and reviewed.

Sky uses a low fixed-fee self-pay model with a public fee table, booking-time selected fee, booking confirmation, standing GFE notice, and pre-charge disclosure for any same-encounter add-on or chat-to-video differential. Sky does not intend to generate a separate individualized Word/PDF estimate before every low-cost telemedicine visit unless counsel advises that a specific workflow is required.