Rehabilitation Associates of Central Virginia (RACV), Inc. is glad to have you as a patient and we are committed to providing you with the best possible care. Please understand… to continue to operate our clinic and provide quality service and care, we must promptly collect for the fees that we charge.
Usual and Customary Fees:
Our fees are what are usual and customary in this area, not what your insurance company has deemed “usual and customary”. You are responsible for any of our fees that your insurance company does not pay, unless we have a contracted fee with your insurance company, or are a network participating preferred provider (PPO) with your insurance company.
We require a 24-hour cancellation/no-show notice. If we do not receive a 24-hour notification, you will be charged a $10 per broken appointment fee that will not be paid by your insurance company and will be your responsibility. If you repeatedly miss scheduled appointments, you will be asked to pursue treatment at our discretion.
If you present a check for insufficient funds, or place a stop payment on an issued check, you will be charged a $30 processing fee. Insufficient funds checks will not be reprocessed. You must pay by cash, credit card or money order.
All proceeds of insurance are assigned to this office where applicable, but without us assuming responsibility for the collection thereof. During your physical therapy treatment, if your insurance coverage changes or is denied, please notify us immediately.
If you are injured on the job, you may have a worker’s compensation claim. You authorize us to file a claim with the Virginia Worker’s Compensation Commissioner in your name. You will cooperate with us at all times concerning the claim and the status thereof. You agree to notify our Worker’s Compensation Billing Agent if you hire an attorney and give us his/her name and address for contact.
You consent and agree that RACV is a third party beneficiary of your insurance contract and is, by your execution below, authorized to file a civil action directly against your insurance company for its fees and costs if payment is delayed or denied by the carrier for any reason. You agree to cooperate fully with RACV in any action filed. This is an assignment to RACV of rights and benefits under your insurance contract to the extent that there are any unpaid fees or costs owed to RACV.