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Charity Policy

ACV, Inc. will honor the charity awarded by Carilion Clinic for patients that do not have insurance. If a patient has insurance, they will still be responsible for any balance due to ACV even if Carilion forgives that balance. ACV has a contract with each insurance carrier that requires us to collect balances owed. This includes copays and deductibles.

ACV, Inc. will make every effort to work with any patient that is not able to pay their anesthesia bill in full when it is due. Due to our contracts with insurance companies, we cannot offer a discount to our insured patients. We do offer an interest-free payment plan that we will help the patient set up. Each patient should contact the office to set up a payment plan after they receive their first bill. Once a payment plan is set up, payment is expected every 30 days until the account is paid in full. Payments should be no less than 20% of the account balance. If a patient defaults on this agreement, the account will be sent to collections with the full balance due.
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If a patient is uninsured and does not qualify for Carilion’s Charity Care, ACV, Inc. will offer the patient a 50% discount that will be applied to their account after the first payment is made. It is the patient’s responsibility to call the office and inform us if they do not have insurance. If a patient cannot pay the remaining balance in full, they may set up a payment plan. Each patient should contact the office to set up a payment plan after they receive their first bill. Once a payment plan is set up, payment is expected every 30 days until the account is paid in full. Payments should be no less than 20% of the account balance. If a patient defaults on this agreement, the account will be sent to collections with the original charge amount.

If a patient receives Charity Care from Carilion and they do not have insurance, ACV will honor the Carilion discount in the following manner:

40% – 65% discount from Carilion = 50% discount from ACV
75% discount from Carilion = 75% discount from ACV
100% discount from Carilion = 100% discount from ACV

ACV, Inc. will send each patient a bill for the services that it renders. The billing shall indicate the balance that remains due and the patient shall have an opportunity to pay the balance that is due. In the event that payment is not received and the patient fails to seek and receive financial assistance, ACV may elect to send the account to its attorney for collection. Prior to that, a final invoice and notice will be sent to the patient giving them 30 days to pay the balance in full.

In the event the account is not paid and is sent to the attorney for ACV, the attorney will send an initial letter indicating that they have the account for collection. They may elect at their discretion to file suit to seek judgment following the expiration of 30 days from the date of their letter, or 120 days from the due date of our final invoice, whichever is later. Post-judgment, wages may be garnished, liens may be filed against real estate, and interrogatories may be filed requiring a court appearance from the patient or guarantor. It is possible that the parties may reach agreement on a payment arrangement or plan to be made to resolve the debt over some time. However, it is within the discretion of ACV as to whether the offered plan is suitable to allow the debt to be repaid in a sufficient time.

 

BALANCE BILLING PROTECTION FOR OUT-OF-NETWORK SERVICES

Starting January 1, 2021, Virginia state law may protect you from “balance billing” when you get:

  • EMERGENCY SERVICES from an out-of-network hospital, or an out-of-network doctor or other medical provider at a hospital; or
  • NON-EMERGENCY SURGICAL OR ANCILLARY SERVICES from an out-of-network lab or health care professional at an in-network hospital, ambulatory surgical center or other health care facility.

What is balance billing?

  • An “IN-NETWORK” health care provider has signed a contract with your health insurance plan. Providers who haven’t signed a contract with your health plan are called “OUT-OF-NETWORK” providers.
  • In-network providers have agreed to accept the amounts paid by your health plan after you, the patient, have paid for all required cost sharing (copayments, coinsurance and deductibles for covered services).
  • But, if you get all or part of your care from out-of-network providers, you could be billed for the difference
    between what your plan pays to the provider and the amount the provider bills you. This is called “balance billing.”
  • The new Virginia law prevents certain balance billing, but it does not apply to all health plans.

Applies

  • Fully insured managed care plans including those bought through HealthCare.gov
  • The state employee health plan
  • Group health plans that opt-in

May Apply

  • Employer-based coverage
  • Health plans issued to an employer outside Virginia
  • Short-item limited duration plans

Does Not Apply

  • Health plans issued to an association outside Virginia
  • Health plans that do not use a network of providers
  • Limited benefit plans

How can I find out if I am protected?

Be sure to check your plan documents or contact your health plan to find out if you are protected by this law. When you schedule a medical service, ask your health care provider if they are in-network. Insurers are required to tell you (on their websites or on request) which providers are in their networks. Hospitals and other health care providers also must tell you (on their websites or on request) which insurance plans they contract with as in-network providers. Whenever possible, you should use in-network providers for your health care to avoid paying more.

After you receive medical services, your health plan will send you an “Explanation of Benefits” (EOB) that will tell you what you must pay the provider. Save the EOB and check that any bills you receive are not more than the amount listed.

When you cannot be balance billed:

If the new law applies to your health plan, an out-of-network provider can no longer balance bill or collect more than your
plan’s in-network cost-sharing amounts for either (1) emergency care or (2) when you receive lab or professional services (like surgery, anesthesiology, pathology, radiology, and hospitalist services) at an in-network facility.

What should I know about these situations?

Your cost-sharing amount will be based on what your plan usually pays an in-network provider in your area. These payments must count toward your in-network deductible and out-of-pocket limit. If the out-of-network provider collects more than this from you, the provider must refund the excess with interest.
Exception: If you have a high deductible health plan with a Health Savings Account (HSA) or a catastrophic health plan, you must pay any additional amounts your plan is required to pay to the provider, up to the amount of your deductible.

What if I am billed too much?

If you are billed an amount more than your payment responsibility shown on your EOB, or you believe you’ve been wrongly billed, you can file a complaint with the State Corporation Commission’s (SCC) Bureau of Insurance.

To contact the SCC regarding questions about this notice visit: scc.virginia.gov or call: 1-877-310-6560.