Financial Responsibility Policy

This Financial Responsibility Policy outlines payment expectations for services provided by Lavender Integrative Psychiatry. By scheduling services, you agree to the following terms.

1. Payment Due at Time of Service

Payment is due at the time services are rendered unless other arrangements have been made in advance.

A valid credit or debit card must be kept on file.

The practice reserves the right to charge the card on file for balances due, including copays, coinsurance, deductibles, late fees, and missed appointment fees.

2. Insurance

If you are using insurance:

• You are responsible for verifying your benefits.
• You are responsible for all copays, coinsurance, and deductibles.
• Verification of benefits is not a guarantee of coverage.

If insurance denies a claim, you are financially responsible for the full balance.

3. Out-of-Network Benefits

If the practice is out-of-network with your insurance:

• Payment in full is required at the time of service.
• A superbill may be provided upon request for reimbursement submission.
• Reimbursement is not guaranteed and depends on your insurance plan.

4. Self-Pay Services

If you are paying out-of-pocket:

• The full session fee is due at the time of service.
• Fees will be discussed prior to treatment.

5. Outstanding Balances

Accounts with unpaid balances may result in:

• Suspension of future appointments
• Referral to collections if unpaid after reasonable notice

The practice reserves the right to discontinue services for nonpayment, consistent with ethical and legal obligations.

6. Returned Payments

Returned checks or failed payment transactions may incur an additional processing fee.

7. Good Faith Estimate

If you are uninsured or not using insurance, you have the right to receive a Good Faith Estimate of expected charges in accordance with federal law.

8. Fee Changes

Fees are subject to change with reasonable notice.

9. Acknowledgment

By scheduling or receiving services, you acknowledge that you have read, understood, and agreed to this Financial Responsibility Policy.

Contact Information

Lavender Integrative Psychiatry
Elizabeth Rose Lavender | PMHNP, AGNP
Email: info@lavenderintegrativepsychiatry.com
Website: www.lavenderintegrativepsychiatry.com
Phone: 774-209-2291