Good Faith Estimate

Your Right to a Good Faith Estimate

Under the law, health care providers need to give patients who don't have insurance or who are not using insurance an estimate of the bill for medical items and services.

• You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services.
• Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item.
• You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
• If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
• Make sure to save a copy or picture of your Good Faith Estimate.

How we provide a Good Faith Estimate

Sunshine Psychiatry Consult is a sole-practitioner telehealth psychiatry practice. Our standard self-pay rate is $75 per session. Because we are a single-clinician outpatient practice and do not bill for facility fees, anesthesia, or third-party clinicians, your Good Faith Estimate is straightforward and based on the visit type you and the clinician anticipate.

If you are uninsured, or if you have insurance but choose not to use it, we will provide a written Good Faith Estimate before your first scheduled session, and on request before any subsequent service. To request an estimate before booking, contact us at [Email — placeholder].

Your estimate will identify the expected services (for example, an initial psychiatric evaluation versus a routine follow-up), the diagnosis codes that are reasonably expected, the associated charges, and the provider's National Provider Identifier (NPI) and Tax Identification Number (TIN). Costs may differ from the estimate if your clinical needs change during care.

Dispute resolution

If you receive a final bill that is at least $400 more than the Good Faith Estimate for any single provider, you may be eligible to dispute the bill through the federal Patient-Provider Dispute Resolution process.

• Phone: 1-800-985-3059
• Web: cms.gov/nosurprises

Initiating a dispute does not adversely affect the quality of health care services you receive from us.

Keep your estimate

We will email your Good Faith Estimate through our secure client portal and keep a copy in your record. We recommend saving a copy or screenshot for your own files.