Legal
Good Faith Estimate
For self-pay patients, as required by the No Surprises Act.
Your right to know the cost
If you do not have insurance or choose not to use it, you have the right to receive a Good Faith Estimate of expected charges before you schedule care. Current self-pay fees are listed in the Services & Fees section, from $175 for a medication follow-up to $425 for an adult ADHD assessment.
What the estimate covers
Your written estimate, provided at or before scheduling, lists the expected services and their charges for your course of care. It is an estimate: the actual services you receive may differ if your clinical needs change, and you will be told about any change before it happens.
If you are billed more
If you receive a bill that is at least $400 more than your Good Faith Estimate, you may dispute it through the federal patient–provider dispute process. Information on starting a dispute is available at cms.gov/nosurprises.
Request an estimate
To request a written Good Faith Estimate, contact the practice at hello@ferncrestpsychiatry.com or +1 (206) 555-0147. Keep a copy of your estimate for your records.