1. Who May Receive an Estimate
Under federal law, healthcare providers generally must provide a Good Faith Estimate to a person who:
Does not have health insurance
Does not have coverage for the scheduled service
Chooses not to use health insurance for the service
Requests an estimate before scheduling
Schedules eligible care at least three business days in advance
The estimate explains expected charges before care is provided.
2. What the Estimate Includes
A Good Faith Estimate includes an itemized list of healthcare items and services reasonably expected to be provided in connection with scheduled care.
It may include:
Appointment type
Expected service date
Expected charge
Provider information
Service or diagnosis codes where required
Related services reasonably expected to be provided
Unexpected services that could not reasonably have been anticipated may not be included.
Services from another provider or facility may require a separate estimate.
3. When You Should Receive It
If care is scheduled between three and nine business days in advance, the estimate generally should be provided within one business day after scheduling.
If care is scheduled at least ten business days in advance, the estimate generally should be provided within three business days after scheduling.
If an estimate is requested before scheduling, it generally should be provided within three business days after the request.
The estimate may be provided electronically or on paper.
4. Requesting an Estimate
To request a Good Faith Estimate, contact:
PsycheMD Psychiatry PLLC
000 Cedar Avenue, Suite 410
Seattle, WA 98101, USA
Do not send medical information through general email unless the practice instructs you to use an approved secure method.
5. If Your Bill Is Higher
If a final bill from a provider or facility is at least $400 more than the amount listed for that provider or facility in the Good Faith Estimate, you may be eligible to use the federal patient-provider dispute-resolution process.
A dispute generally must be started within 120 calendar days after receiving the bill.
Starting a dispute does not automatically remove responsibility for amounts properly owed.
Federal requirements and administrative fees may apply.
6. Keep Your Estimate
Keep a copy of your Good Faith Estimate.
You may need it to:
Compare estimated and billed charges
Ask the practice questions
Correct an error
Begin a patient-provider dispute
Contact PsycheMD if another copy is needed.
7. Contact PsycheMD
For questions about expected charges or a Good Faith Estimate:
PsycheMD Psychiatry PLLC
000 Cedar Avenue, Suite 410
Seattle, WA 98101, USA
This page explains the right to receive an estimate. It is not an individual Good Faith Estimate.