Good Faith Estimate

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You have the right to receive a “Good Faith Estimate” that explains how much your medical care is expected to cost.

Under the No Surprises Act, health care providers must give patients who do not have insurance, or who choose not to use insurance, an estimate of expected charges for medical services.

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Your Rights Include:

• The right to receive a Good Faith Estimate for the total expected cost of any non-emergency telepsychiatry services

• The right to receive this estimate in writing at least 1 business day before your appointment

• The option to request a Good Faith Estimate before scheduling any service

• The ability to dispute a bill if the final charges are at least 400 dollars more than the estimate provided

 

The Estimate May Include Costs Related to:

• Psychiatric evaluations

• Medication management visits

• MOUD or Suboxone appointments

• Prescription-related services (excluding the cost of medication at the pharmacy)

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Keep a Copy of Your Estimate

Please save a copy of any Good Faith Estimate you receive for your records.

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Where to Learn More

For questions about your rights under the No Surprises Act, visit:
www.cms.gov/nosurprises