The "No Surprises Act" includes certain protections for patients to prevent large, unexpected medical bills.  One of those protections is a requirement that health care facilities and practitioners provide certain patients with a Good Faith Estimate (GFE).  A GFE is an estimate of the total expected cost of any health care item or service that is provided before that item or service is delivered.  It is similar to the kind of estimate you might get from your auto mechanic.

Sometimes it can be difficult to predict the total cost of your psychiatric care before your appointment or an initial assessment is completed.  The total cost of psychiatric treatment is influenced by several factors including the severity of your symptoms, the kinds of medications prescribed, the frequency of appointments, and any unforeseen complications that could arise.  This estimate is a best guess about how much your care may cost, and actual services and items rendered may differ.

In short, patients who are paying for their health care themselves, or "self pay" patients.  

This includes patients who do not have health insurance, and patients who have health insurance through a group, individual or federal benefits plan, but either do not plan to use their insurance to pay for a particular service, or who are aware that their health insurance will not cover a certain service, and therefore will be paying for that service themselves.

You have a right to receive a GFE from a health care facility or practitioner any time you ask for one.  If you would like to request a GFE from Sequoia Psychiatry, please use the button below to access the request form.

Additionally, self-pay patients are entitled to receive a GFE when they schedule an appointment at least three business days in advance.  For appointments scheduled 3-9 business days in advance, patients should expect to receive a GFE within 1 business day.  For appointments scheduled at least 10 business days in advance, patients should expect to receive a GFE within 3 business days.

When a GFE is issued to a patient or potential patient, a copy of the GFE will be placed in their medical record for reference.

If you have questions about the bill you receive, or you notice differences between your GFE and the bill, please contact me so that I can review the bill for errors, or explain any unplanned charges.

Additionally, if you receive a bill that is at least $400 in excess of the GFE you received, you can dispute that bill through the Patient-Provider Dispute Resolution (PPDR) process by submitting a notice of initiation through CMS.

Visit: www.cms.gov/nosurprises/consumers

Email: FederalPPDRQuestions@cms.hhs.gov

Phone: 1-800-985-3059