Good Faith Estimate
You have the right to know what your care will cost, in writing, before you receive it.
What the Good Faith Estimate covers
Under Section 2799B-6 of the Public Health Service Act (the No Surprises Act), you have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. At Backcountry Mental Health, this includes:
- Initial psychiatric evaluations
- Initial primary care evaluations
- Medication management visits
- Individual psychotherapy sessions
- Any related items or services provided as part of your care
If you receive ongoing care, your estimate will show the expected charges for the full course of treatment over the coming year, based on your anticipated visit frequency.
When you’ll receive your estimate
- You will receive a written Good Faith Estimate at least 1 business day before your scheduled service (or at least 3 business days before, if you schedule 10 or more business days in advance).
- You can also ask for a Good Faith Estimate before you schedule any service. No appointment required.
- Your estimate will be provided in writing, and we’re happy to explain it by phone or during your visit.
If your bill is higher than your estimate
If you receive a bill that is 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 the dispute within 120 calendar days of the date on your bill.
Make sure to save a copy or picture of your Good Faith Estimate.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 1‑800‑985‑3059.
Request your Good Faith Estimate
Email us and we will send you a written estimate based on the services you expect to receive, before you ever book an appointment.
Email Us for an Estimate