Good Faith Estimate

Your right to understand the cost of your care

If you don't have health insurance, or you choose not to use your insurance to pay for your care, you have the right to receive a Good Faith Estimate explaining how much your care is expected to cost.

Under the federal No Surprises Act, health care providers are required to provide uninsured and self-pay patients with an estimate of the expected charges for scheduled non-emergency services.

When will I receive a Good Faith Estimate?

If you are uninsured or planning to pay for your care without using insurance, you may ask for a Good Faith Estimate before scheduling an appointment.

You are also entitled to receive one when eligible services are scheduled in advance:

  • If your appointment is scheduled 3–9 business days in advance, your estimate should generally be provided within 1 business day after scheduling.

  • If your appointment is scheduled 10 or more business days in advance, your estimate should generally be provided within 3 business days after scheduling.

  • If you request an estimate before scheduling care, it should generally be provided within 3 business days of your request.

Your Good Faith Estimate will be based on the care that is reasonably expected at the time the estimate is prepared. Your treatment needs may change over time, so an estimate is not a guarantee of your final cost.

What if my bill is higher than my estimate?

Keep a copy of your Good Faith Estimate so you can compare it with any bills you receive.

If the amount billed by a provider or facility is at least $400 more than the amount listed on your Good Faith Estimate, you may be eligible to dispute the charge through the federal patient-provider dispute resolution process.

In general, a dispute must be started within 120 calendar days of the date on your original bill.

For more information about your rights under the No Surprises Act or the dispute process, visit the Centers for Medicare & Medicaid Services' No Surprises resources or call the No Surprises Help Desk at 1-800-985-3059.

Questions about your estimate?

If you're unsure whether a Good Faith Estimate applies to you or would like to request one, please contact Sage Perinatal Psychiatry.

Email: tiffany@sage-psychiatry.com
Phone: (657) 325-7607

Please do not include sensitive medical or personal information in standard email communications.