Your Right to a Good Faith Estimate

Under the federal No Surprises Act, individuals who do not have insurance or who are not using insurance to pay for their care generally have the right to receive a Good Faith Estimate explaining the expected cost of scheduled health care services.

What this means for you

If you are uninsured or choose not to use insurance for your care, you have the right to:

• Receive a Good Faith Estimate of the expected charges for scheduled services.

• Ask for a Good Faith Estimate before scheduling a service.

• Receive the estimate in writing, including electronically if requested.

• Keep a copy of your estimate for your records.

A Good Faith Estimate is based on the information available when it is created. Your actual treatment needs may change over time, and the estimate does not require you to receive the services listed.

If your bill is substantially higher than your estimate

If you receive a bill that is at least $400 more than your Good Faith Estimate from a particular provider or facility, you may be eligible to use the federal patient-provider dispute resolution process.

Starting a dispute will not adversely affect the quality of care you receive.

For additional information about your rights under the No Surprises Act or the Good Faith Estimate dispute process, visit the federal Centers for Medicare & Medicaid Services information for consumers.

Fees at LiveWell Psychiatry

LiveWell Psychiatry is a private-pay practice.

Initial psychiatric evaluation — $375
30-minute follow-up — $150
50-minute follow-up — $225

Psychotherapy — $175

Payment is due according to the practice's financial policies. Superbills may be provided for patients who wish to seek possible out-of-network reimbursement from their insurance plan. Reimbursement is determined by the individual insurance plan and is not guaranteed.

If you have questions about the expected cost of your care or would like a Good Faith Estimate, please contact the practice.

LiveWell Psychiatry, LLC
Phone: 207-808-0405
Email: khoyt@lwpsych.org