SIGMAYour Right to a Good Faith Estimate
Under federal law, you have the right to receive a Good Faith Estimate of what your care is expected to cost.
You have the right to a Good Faith Estimate
You have the right to receive a Good Faith Estimate of the expected charges for your medical care if you're uninsured, or if you have insurance but choose not to use it and instead pay on your own (sometimes called self-pay). This right comes from the federal No Surprises Act. It applies to our California patients, whose care is private-pay, and to any other patient who's uninsured or who chooses to self-pay.
A Good Faith Estimate shows the costs of items and services that are reasonably expected for your care. It's an estimate based on the information known at the time we create it. It isn't a bill, and it isn't a contract. The actual items, services, and charges may differ, for example if your care changes or you need more visits than expected.
What the estimate includes
When we prepare your Good Faith Estimate, it will include information such as the name of our practice and the clinician providing your care, a description of the services we expect to provide (for example, an initial psychiatric evaluation or follow-up medication-management visits), and the expected charge for each service, along with other details the law requires.
How to ask for one
You can ask for a Good Faith Estimate at any time. We'll also provide one automatically when you schedule care, within the timeframe the law requires.
- When you schedule a service, we'll give you a Good Faith Estimate in writing within the time the law requires after scheduling.
- You can also request a Good Faith Estimate before you schedule, simply by asking. When you request one, we'll give it to you in writing within the time the law requires after your request.
- We'll provide the estimate in writing, on paper or electronically, whichever you prefer, and we'll explain it to you if you have questions.
To request a Good Faith Estimate, contact us at RamyMD@sigmapsych.net or ask during your intake call. Be sure you receive your Good Faith Estimate in writing before your visit.
Your right to dispute a bill
If you receive a bill that's at least $400 more than your Good Faith Estimate for any single provider, you have the right to dispute the bill.
You may contact us to let us know the billed charges are higher than the estimate. You can ask us to update the bill, ask questions about it, or negotiate. You also have the right to start a formal dispute resolution process with the federal government.
To use the federal patient-provider dispute resolution process, you must start your dispute within 120 calendar days of the date on the bill. There's a small administrative fee to use the process. If the dispute review agency agrees with you, you may owe the lower amount in the Good Faith Estimate. If it disagrees, you may owe the billed amount. Using the dispute process doesn't affect the quality of care you receive from us.
For more information about your right to a Good Faith Estimate and the dispute process, visit www.cms.gov/nosurprises or call 1-800-985-3059.
Keep your estimate
Keep a copy of your Good Faith Estimate in a safe place. You may need it if you're billed more than the estimate and you want to dispute the bill. We also keep a copy of each Good Faith Estimate we provide as part of our records.