Effective Date: 1 August 2026

This Financial Policy explains your financial responsibilities when receiving services from Integrated Wellness Behavioral Health ("we," "our," or "us"). By scheduling an appointment or receiving services, you agree to the terms below.

1. Insurance and Payment Responsibility
- If we accept your insurance, we will bill your insurance company as a courtesy.
- You are responsible for:
- Copayments, coinsurance, and deductibles.
- Any services not covered by your insurance plan.
- Providing accurate and current insurance information.
- If your insurance denies or does not pay a claim, the remaining balance is your responsibility.
- If you do not have insurance or we are out-of-network, payment is due at the time of service unless other arrangements have been made.

2. Self-Pay and Cash Rates
- If you choose to self-pay (not use insurance), you are responsible for paying the full fee at the time of service.
- We may offer specific cash rates or packages, which will be explained to you in advance.

3. No-Show and Late Cancellation Policy
- Your appointment time is reserved just for you. Late cancellations and missed appointments make it hard for us to offer that time to other patients.
- Cancellations: If you need to cancel or reschedule, please notify us at least 48 hours before your appointment.
- Late cancellations: Appointments canceled with less than 48 hour notice may be charged a late cancellation fee of [Insert Fee Amount, e.g., $75 or full session fee].
- No-shows: If you do not come to your appointment and do not notify us, you may be charged a no-show fee of [Insert Fee Amount, e.g., $75 or full session fee].
- These fees may not be covered by insurance and will be your responsibility.
- Repeated late cancellations or no-shows may result in termination of services at our discretion.

4. Telehealth Appointments
- The same no-show and late cancellation policies apply to telehealth (video or phone) appointments.
- You are responsible for having a private space and a reliable connection for telehealth sessions.

5. Payment Methods and Balances
- We accept [Insert Accepted Payment Methods, e.g., credit/debit cards, HSA/FSA cards, checks, cash].
- Payment is due at the time of service unless other arrangements have been made.
- Any remaining balance after insurance processes your claim is due upon receipt of your statement.
- If your account becomes past due, we may:
- Send reminders or statements.
- Require payment before scheduling future appointments.
- Use a collection agency or other lawful means to collect unpaid balances.

6. Forms, Letters, and Additional Services
- Fees may apply for completing forms, writing letters, or preparing reports that are not part of routine clinical care (for example, disability forms, FMLA paperwork, or detailed letters).
- These fees will be explained to you before the service is provided.

7. Returned Payments
- If a check or electronic payment is returned or declined, you may be charged a returned payment fee of [Insert Fee Amount].
- You may be asked to use a different form of payment for future services.

8. Changes to Fees and Policies
- Our fees and this Financial Policy may change over time.
- When changes occur, we will update this policy and may provide notice by posting the updated version and/or informing you at your visit.

9. Questions
If you have questions about this Financial Policy, your balance, or your insurance coverage, please contact us at:

Integrated Wellness Behavioral Health
1992 Lewis Turner Blvd, Suite 1172
Fort Walton Beach, FL 32547
850-343-5602

By receiving services from our practice, you acknowledge that you have read, understood, and agree to this Financial Policy, including the no-show and late cancellation fees.