Good Faith Estimate
If you are uninsured, or insured and choosing not to use your insurance for your care here, you have the right to a written estimate of what your treatment will cost before you are seen.
What you are entitled to
Under federal law, health care providers must give patients who are uninsured or who are not using insurance an estimate of the expected charges for medical services, including psychotherapy services.
You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency services. That includes related costs such as the initial appointment and any ongoing sessions expected over the following twelve months.
When you will get it
- If your appointment is at least ten business days away, within three business days of scheduling
- If your appointment is three to nine business days away, within one business day of scheduling
- If you ask for one without scheduling, within three business days of asking
- An updated estimate before we bill you at different terms, if your expected charges change
What the estimate contains
- Your name and date of birth
- The name of the clinician who will see you, their National Provider Identifier and tax identification number, and where you will be seen
- A plain description of each service, with its billing code and itemised charge
- For ongoing care, the expected frequency and number of sessions over twelve months
- The disclaimers required by federal law, including your right to dispute a bill
If your bill is higher than the estimate
If you are billed at least $400 more than your Good Faith Estimate, you can dispute the bill through the federal patient-provider dispute resolution process. You must start that process within 120 calendar days of the date on your bill.
Keep a copy of your estimate. Ask us for another one at any time and we will send it.
How to request one
Call us and ask. You do not have to book anything first, and you do not have to give a reason.
Your estimate is prepared by Brandon Audia, our Executive Director, and reaches you through the SimplePractice client portal, the same portal you use for your paperwork and appointments. If you would rather have it on paper, say so and we will print it.
Every estimate carries our practice NPI, 1437948635, along with our tax identification number and the NPI of the clinician you are scheduled to see. Those are there so the numbers on your estimate line up with the numbers on your bill, which is what makes the two comparable if you ever need to dispute one.
Questions about this page? Call (480) 525-3770 or write to us at 605 E Broadway Rd, Tempe, AZ 85282.