Card-on-File

We encourage patients to keep a credit card on file to make the checkout process easier, faster, and more efficient. You will no longer receive statements from us, but you will continue to receive your Explanation of Benefits (EOB) from your insurance carrier once your claim has been processed, detailing the charges and payments made on your behalf.

At check-in we will:

• scan the credit card of your choice, including your Flexible Spending Account (FSA) or Health Savings Account (HSA) card

After your insurance has paid their portion, we will:

• notify you via email of the balance owed
• charge the balance owed to your card on file
• email a receipt for the charge

Your credit card information will always be fully protected by our off-site, card-processing partner Elavon, and not on our computers, as required by industry standards (Payment Card Industry Data Security Standard – PCI-DSS).

Privia Medical Group’s Payments Contract

I agree to allow Privia Medical Group to charge my credit card for any amount not covered by insurance (up to the maximum charge amount), for all services provided by Privia Medical Group to the patient(s) on or after the effective date and before the expiration date. I acknowledge that:

• My credit card will be charged upon review of the final explanation of benefits from each applicable insurance company for services provided while this agreement is in effect.
• The maximum total charged to the card on file is $150 for a Single Appointment and $1,500 for One Year.
• Once a total has been charged to my credit card under this agreement, Privia Medical Group will bill me directly for any amounts not covered by insurance.
• My credit card will be stored by Elavon, Inc., a secure credit card processor affiliated with U.S. Bank that partners with Privia Medical Group to collect payments.
• I will receive receipts detailing the amount charged.
• I may cancel this agreement at any time by contacting Privia Medical Group; any unpaid amounts relating to services provided while this agreement is in effect that are not covered by insurance will then be billed to me directly.