Your Right to a Good Faith Estimate

You have the right to receive a Good Faith Estimate of what your care will cost

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 expected charges for medical services.

You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency services. This includes psychiatric evaluations, follow-up visits, and any related services we provide.

• You can ask your provider, and any other provider you choose, for a Good Faith Estimate before you schedule a 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.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 1-800-985-3059.

How this works at our practice

Because Refresh Dallas Psychiatry is a self-pay and in-network outpatient telepsychiatry practice, here is what to expect:

• If you are using insurance, we verify your benefits before your first visit and tell you your expected cost-sharing, copay, coinsurance, or deductible, in advance. See our insurance page.
• If you are paying out of pocket, we will provide a written Good Faith Estimate of your expected charges before your first visit, on request and as required by law.
• We do not balance-bill, and we tell you your expected costs before you commit to anything.

A note on emergencies

We are an outpatient telepsychiatry practice and do not provide emergency care. If you are experiencing a mental health emergency, call or text 988, call 911, or go to your nearest emergency room. The federal No Surprises Act protections against surprise bills for emergency and certain out-of-network care apply primarily to hospital and facility settings; this notice concerns your Good Faith Estimate right as a self-pay or uninsured patient.