Good Faith Estimate & No Surprises Act

Good Faith Estimate

Under the No Surprises Act, patients who do not have insurance or who choose not to use their insurance have the right to receive a Good Faith Estimate of expected charges for scheduled healthcare services.

Ayr Mental Health PLLC will provide a Good Faith Estimate outlining the expected cost of services before care begins. This may include psychiatric evaluations, medication management visits, ADHD evaluations, and other services provided as part of your treatment. For ongoing care, your estimate may cover up to 12 months of expected visits.

You may request a Good Faith Estimate before scheduling services or at any time during your care. You will receive your estimate in writing:

- Within 1 business day of scheduling, if you schedule a service at least 3 business days in advance

- Within 3 business days of scheduling, if you schedule a service at least 10 business days in advance

- Within 3 business days of your request, if you ask for an estimate without scheduling

Please review your estimate carefully and keep a copy for your records. A Good Faith Estimate is not a contract and does not require you to receive the services listed.

If the final charges you receive are at least $400 more than the amount listed on your Good Faith Estimate, you have the right to dispute the bill through the federal patient-provider dispute resolution process. You must start the dispute within 120 calendar days of the date on your bill.

For more information about your rights under the No Surprises Act and Good Faith Estimates, visit https://www.cms.gov/medical-bill-rights, or call the No Surprises Help Desk at 1-800-985-3059