Self-Pay Patient Rights
Good Faith Estimate
If you do not have health insurance, or you choose not to use insurance for your care, federal law generally gives you the right to receive a written Good Faith Estimate of expected charges before scheduled services.
When you can receive an estimate
Valiant Psychiatry will provide a Good Faith Estimate when federal rules require it, including when an uninsured or self-pay patient schedules care at least three business days in advance or requests an estimate. Emergency care is not included in this estimate process.
You do not need to use the words “Good Faith Estimate” to ask for one. Tell the practice that you are not using insurance and would like expected charges in writing.
What the estimate covers
- The reasonably expected charges for the health-care items or services Valiant expects to provide, based on information known when the estimate is prepared.
- Information identifying the scheduled or requested service, the provider, and applicable diagnosis or service codes when required.
- A notice explaining that the estimate is not a contract and that additional items or services may be recommended or needed.
Current federal guidance generally requires each provider or facility to supply its own estimate. If other providers or facilities may be involved, you may request a separate estimate from each one.
If the final bill is substantially higher
Keep your written estimate and compare it with your bill. If a bill from a provider or facility is at least $400 more than that provider’s Good Faith Estimate, you may be able to use the federal patient-provider dispute resolution process. The dispute generally must be started within 120 calendar days of receiving the initial bill.
An independent dispute-resolution entity reviews the estimate, bill, and supporting information. A $25 non-refundable administrative fee is currently required to start the federal process. Starting a dispute does not prevent you and the provider from continuing to negotiate. Federal rules also restrict collection activity, late fees, and retaliation while an eligible dispute is pending.
Request a Good Faith Estimate
Call 801-252-6044 or email gabriel@myvaliantpath.com and explain that you are uninsured or do not plan to use insurance for the service. Please avoid sending detailed clinical information by ordinary email.
A Good Faith Estimate is not a bill and does not require you to receive care from Valiant Psychiatry.
Learn more about your federal rights
Visit the Centers for Medicare & Medicaid Services medical-bill-rights site or call 1-800-985-3059 for federal information and help.