Good Faith Estimate

You have the right to receive a Good Faith Estimate explaining how much your care is expected to cost.

If you do not have health insurance or are not using insurance for these services, you can receive a written estimate of the expected charges. This includes the services reasonably expected as part of your scheduled care.

You may request an estimate before scheduling. If you book care 3–9 business days ahead, we provide the estimate within 1 business day after scheduling. If you book 10 or more business days ahead, we provide it within 3 business days. Estimates requested before scheduling are provided within 3 business days.

Your first estimate may cover the initial evaluation only. If ongoing care is recommended, we can provide a separate estimate for follow-up visits. An estimate does not require you to receive treatment.

If a provider or facility bills you at least $400 more than its estimated charges, you may qualify to dispute the bill through the federal patient-provider dispute resolution process. Keep a copy of your estimate and bill.

To request an estimate, call Syracuse Integrative Psychiatry at 315-607-9417. Please let us know if you need the notice or estimate in an accessible format or another language.

For information about your rights, visit www.cms.gov/nosurprises or call 1-800-985-3059.