Financial and Payment Policy
Download the unified policy (PDF)The complete Unified Privacy, HIPAA, and Financial Policy — revised August 24, 2026.
This policy explains patient financial responsibility, insurance billing, payments, refunds, and fees. The complete Unified Privacy, HIPAA, and Financial Policy (revised August 24, 2026) is available as a PDF on this page.
Patient responsibility
Provide accurate insurance and demographic information and pay all co-pays, co-insurance, deductibles, and balances not paid by insurance.
Insurance billing
CVI may bill your insurer as a courtesy; coverage is not guaranteed. You are responsible for all charges not paid by your insurer.
Refunds
Refunds are granted only for verified overpayments, duplicate charges, or unauthorized transactions, and are issued to the original payment method whenever possible.
Chargebacks
Please contact CVI first to resolve any dispute before initiating a chargeback. Unwarranted chargebacks may result in recovery of related administrative costs (up to $35 per occurrence).
Credit card surcharge
Credit card payments to Crown Valley Imaging, LLC / Crown Valley Radiologists, Inc., APMC carry a 3.5% surcharge, disclosed before you complete payment. Self-pay scans purchased through our online shop are charged the listed price with no surcharge. The surcharge applies to payments for services only — it never applies to obtaining your medical records.
Getting your records is free
Obtaining copies of your own medical records and imaging through our patient portal, CVI Connect, at connect.crownvalleyimaging.com, is free. Records access and billing are separate: we do not charge for electronic copies through the portal, and we never withhold records because of an outstanding balance (Cal. Health & Safety Code §123110(j)). Cost-based fees may apply only to paper copies or another format you ask for. See our HIPAA Notice of Privacy Practices for the full details.
Returned or failed payments
Returned ACH or check payments may incur a $25 fee. CVI may reattempt failed payments.
No-show and late-cancellation fees
Fees apply if you fail to cancel at least 24 hours in advance: $50 per missed X-Ray or DEXA appointment; $75 per missed CT or Ultrasound appointment; $100 per missed MRI appointment.
Communications and e-Sign consent
You consent to receive billing communications electronically (email, SMS, phone, portal) and to the use of electronic signatures under E-SIGN and UETA.
Good Faith Estimates
Upon request or as required by law, CVI provides Good Faith Estimates for self-pay or uninsured patients. Request one on our Insurance & Payment page, by emailing billing@cvimaging.net, or by calling (949) 215-3304.
Collections
Delinquent accounts may be referred to collections consistent with law. Required notices will be provided before any adverse credit reporting.
Billing questions
Contact our billing team at (949) 215-3304 or billing@cvimaging.net.
Questions about this policy? Email support@cvimaging.net or call 949-367-1010.
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