Your Right to a Good Faith Estimate

1Who this applies to

Under the No Surprises Act, healthcare providers must give a Good Faith Estimate of expected charges to patients who are uninsured, or who are insured but not planning to submit a claim to their health plan for the care in question.

Many people choosing self-pay psychiatric care fall into the second group, often deliberately, because a claim puts a diagnosis into an insurance record. That is a legitimate choice and this right exists to support it.

2What the estimate contains

• Your name and date of birth.
• A plain description of the service, for example a comprehensive psychiatric evaluation or a medication management follow-up.
• The expected charge for each service, itemised.
• The relevant service and diagnosis codes.
• The date the service is expected, and where it will be provided.
• A note of anything reasonably expected to be provided separately by someone else, such as laboratory work, which would be billed by that provider rather than by this practice.

An estimate is exactly that. It is not a bill, and it is not a contract to provide the care listed.

3When you receive it

• You do not have to ask. Once care is scheduled, the estimate is provided automatically.
• If the appointment is booked at least ten business days ahead, you receive it within three business days of booking.
• If it is booked between three and nine business days ahead, you receive it within one business day.
• If you ask for an estimate without booking anything, you receive it within three business days of asking.
• It is provided in writing, on paper or electronically as you prefer, and you may ask for it to be explained to you.

4Ongoing treatment

Psychiatric care is usually a course of appointments rather than a single event, so an estimate will normally set out the expected pattern of care, for example an initial evaluation followed by follow-up appointments at a stated interval, with the charge for each.

Treatment changes. If the plan changes materially, for example if appointments become more frequent or a different service is needed, you will be given an updated estimate before that care is provided.

5If your bill is much higher than your estimate

If you are billed at least $400 more than your Good Faith Estimate for a provider, you have the right to dispute the bill through the federal patient-provider dispute resolution process.

• You must start the dispute within 120 calendar days of the date on the bill.
• There is a small administrative fee to begin, which may be waived if you cannot afford it.
• An independent third party reviews the estimate and the bill and decides the amount.
• While a dispute is under way, the provider may not move the disputed amount to collections or charge late fees on it.

Full details, and the forms, are at cms.gov/nosurprises, or call 1-800-985-3059.

6If you are using insurance

The Good Faith Estimate process does not apply where you are submitting a claim to your health plan. In that case your costs depend on your plan's deductible, copay and coinsurance, and your plan is the authority on what you will owe.

The plans this practice is in network with are listed on the Insurance We Accept section of the home page. Participation does change, so confirm your own benefits with your insurer before your first appointment. Email appointments@JonaPsychiatry.com or call to confirm what applies to you.

7How to ask for an estimate

Ask at any point, before or after booking, and you will not be asked to justify the request.

• By phone on (240) 673-7091
• By email to appointments@JonaPsychiatry.com
• Through the appointment request form, noting that you would like an estimate

Keep a copy of your estimate in a safe place. You will need it if you ever want to dispute a bill.