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Patient Rights

Good Faith Estimate

You have the right to know the expected cost of your care before you receive it. Here is what you need to know about your rights under the No Surprises Act.

The No Surprises Act

Effective January 1, 2022, the No Surprises Act (part of the Consolidated Appropriations Act, 2021) provides important protections against surprise medical billing. One key provision of this law is the right to receive a Good Faith Estimate of expected charges for scheduled health care services.

This law was created to help patients better understand and plan for the cost of their care, and to protect against unexpected bills. At Yoma Psychiatric Solutions, we support transparency in health care costs and are happy to provide this information.

What Is a Good Faith Estimate?

A Good Faith Estimate is a written estimate of the expected charges for health care items and services that a provider or facility will furnish to you. It provides an estimate of the total expected cost of any non-emergency health care services, including mental health services such as therapy and psychiatric care.

The estimate includes the expected cost of the primary service and may also include the cost of related services that are reasonably expected to be provided along with it (for example, a series of therapy sessions).

Who Is Entitled to a Good Faith Estimate?

Under the No Surprises Act, you have the right to receive a Good Faith Estimate if:

  • You do not have health insurance, or
  • You choose not to use your health insurance to pay for services (self-pay or out-of-pocket), or
  • You are an insured patient and request an estimate for your expected out-of-pocket costs

All patients are welcome to request a Good Faith Estimate at any time.

Your Rights Under This Law

Under the No Surprises Act, you have the right to:

  • Receive an estimate in advance: You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency health care items or services upon request or when scheduling care.
  • Receive a written estimate: The estimate must be provided in writing (on paper or electronically) in a way that is clear and understandable.
  • Receive the estimate in a timely manner: If you schedule a service at least 3 business days in advance, you should receive the estimate within 1 business day after scheduling. If you schedule a service at least 10 business days in advance, you should receive the estimate within 3 business days after scheduling.
  • Dispute a bill that significantly exceeds the estimate: If you receive a bill that is at least $400 more than your Good Faith Estimate, you have the right to dispute the bill.

How to Request an Estimate

You can request a Good Faith Estimate from Yoma Psychiatric Solutions at any time. To do so, simply:

Please provide the type of service you are seeking (for example, individual therapy, couples counseling, psychiatric evaluation) so we can prepare the most accurate estimate possible.

What If Your Bill Is Different From the Estimate?

A Good Faith Estimate is an estimate, not a binding contract. The actual cost of services may differ based on factors such as session length, additional services needed, or changes in your treatment plan. However, significant differences are addressed by the law.

If you receive a bill that is at least $400 more than your Good Faith Estimate, you have the right to dispute the bill. You should:

  • Save a copy of your Good Faith Estimate for your records.
  • Contact our office first. We are committed to transparent billing and want to resolve any discrepancies directly with you whenever possible.
  • Initiate a formal dispute if needed through the federal dispute resolution process (see below).

Dispute Resolution Process

If you and our office are unable to resolve a billing discrepancy, you may initiate the federal patient-provider dispute resolution process. To start a dispute:

  • Visit the Centers for Medicare & Medicaid Services (CMS) website at www.cms.gov/nosurprises for detailed instructions and to access the dispute resolution form.
  • Call 1-800-985-3059 for assistance with the dispute process.

There may be a small administrative fee associated with initiating a dispute, which may be waived in cases of financial hardship.

Important Notes

  • The Good Faith Estimate does not require you to obtain the services listed.
  • You are not required to choose Yoma Psychiatric Solutions for services simply because you received an estimate.
  • The estimate is valid for the services described and may need to be updated if your treatment plan changes significantly.
  • If you are using insurance, your cost may differ from the Good Faith Estimate based on your specific plan benefits, deductible status, and copay/coinsurance requirements. We recommend contacting your insurance company for the most accurate out-of-pocket estimate.

Contact Information

For questions about Good Faith Estimates, billing, or your rights under the No Surprises Act, please contact us:

For more information about your rights under federal law, visit www.cms.gov/nosurprises.

Questions About Costs?

We believe in transparent, upfront pricing. Contact us to request a Good Faith Estimate or discuss payment options.

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