Your Right to a Good Faith Estimate
Under the federal No Surprises Act, patients have the right to obtain a written estimate of anticipated charges prior to receiving non-emergency care.
Effective date: · Updated annually in accordance with federal law.
You are entitled to receive a “Good Faith Estimate” detailing the anticipated costs of your medical care.
Pursuant to the federal No Surprises Act, healthcare providers must supply patients who are uninsured, or who elect not to submit claims to insurance, with an estimate of expected fees for medical services, including psychiatric and mental health care.
1. Understanding a Good Faith Estimate
A Good Faith Estimate (GFE) is a written notice outlining expected costs for non-emergency healthcare prior to treatment. It includes:
- A clear description of the primary service being scheduled (such as an initial psychiatric assessment).
- An itemized breakdown of expected associated services and their fees.
- Corresponding diagnostic (ICD-10) and procedural (CPT) codes for each service.
- Provider details: full name, National Provider Identifier (NPI), and Tax Identification Number (TIN).
- Service location and scheduled date(s) of care.
- A statement clarifying that the GFE is an estimate, not a binding contract, and that actual fees may vary.
- Notice of your right to initiate a dispute resolution process if the final billed amount exceeds the GFE total by $400 or more.
2. Who qualifies for a GFE
You are eligible to receive a Good Faith Estimate from Intersect Mental Wellness if you are:
- Uninsured (you do not hold active health insurance benefits), or
- Self-pay (you maintain insurance coverage but choose not to use it for care here—for instance, because Intersect Mental Wellness does not bill insurance directly).
Because Intersect Mental Wellness operates as a self-pay practice, most patients qualify to receive a GFE.
3. Delivery timeline for a GFE
Intersect Mental Wellness will issue your written Good Faith Estimate within the following timeframes:
- Within 1-3 business days of booking an appointment.
- Within 3 business days following any explicit request for a GFE.
You may request an estimate prior to booking any service.
4. What the estimate includes
Because outpatient psychiatric care usually involves ongoing visits that fluctuate in frequency and focus based on individual needs, a Good Faith Estimate typically incorporates:
- An initial 75-minute psychiatric intake ($379).
- A standard projection of follow-up visits over a twelve-month period based on clinical guidelines for similar care plans (30-minute follow-ups at $199 per visit and/or 60-minute follow-ups at $339 per visit).
Actual visit frequency is tailored to your specific clinical requirements as determined collaboratively during treatment. The GFE serves as a financial projection, not a mandatory appointment schedule.
The GFE does not encompass care or fees outside of Intersect Mental Wellness (such as external psychological testing, therapy with outside providers, laboratory work, prescription medications, hospital care, or emergency services).
Current visit rates are listed on the pricing page.
5. Contesting a bill
If Intersect Mental Wellness issues a bill that exceeds your Good Faith Estimate by at least $400, you have the legal right to challenge the charges through the federal patient-provider dispute resolution process. Dispute claims must be filed within 120 calendar days of the invoice date. While the claim is under review, you are not required to pay the contested portion.
To begin the dispute process:
- Online: Visit the CMS Medical Bill Disputes page
- Phone: Call CMS at 1-800-985-3059
Note: Submitting a dispute may involve a nominal administrative filing fee (currently $25 as of 2026; check the CMS site for current rates).
6. Requesting your GFE
You can request a Good Faith Estimate at any time—prior to booking or at any stage of treatment—by reaching out to the practice:
Written estimates are delivered securely (typically via encrypted email) within the required statutory windows.
7. Retaining your document
Please save a copy of every Good Faith Estimate provided to you. Should your final charges exceed the estimate by $400 or more, you will need the GFE document to file an official dispute.
This notice outlines your rights under federal No Surprises Act regulations (45 CFR § 149.610). It is provided for informational purposes and does not constitute legal counsel. For complete details on federal billing regulations, visit cms.gov/nosurprises or speak with a licensed legal professional.