Good Faith Estimate

Your Right to Know What Care May Cost

Grounded Psychiatry is a private-pay practice and does not accept insurance.


If you are paying out of pocket for services, you have the right to receive a Good Faith Estimate of expected charges under the No Surprises Act.

A Good Faith Estimate helps you understand the anticipated cost of non-emergency mental health care before you receive services.

  

What Is a Good Faith Estimate?

A Good Faith Estimate is a written explanation of the expected costs for your care based on the information available at the time it is provided. This estimate includes anticipated fees for services that are reasonably expected to be provided.

Because care is individualized and may change based on clinical needs, the estimate is not a guarantee of final charges.

  

Who Can Request a Good Faith Estimate?

You have the right to request a Good Faith Estimate if you:

  • Are uninsured, or

  • Are choosing not to use insurance and are paying privately for services

This applies to all non-emergency services offered by Grounded Psychiatry.

  

When Will I Receive a Good Faith Estimate?

You may request a Good Faith Estimate:

  • Before scheduling services

  • When scheduling an appointment

  • At any time prior to receiving care

If services are scheduled in advance, we will provide the estimate within the timeframes required by

 

What If My Bill Is Higher Than My Estimate?

If you receive a bill that is at least $400 more than your Good Faith Estimate, you have the right to dispute the bill through a federal patient-provider dispute resolution process.

We encourage you to keep a copy of your Good Faith Estimate for your records.

  

How to Request a Good Faith Estimate

To request a Good Faith Estimate, please contact us prior to your appointment:

📧 Email: support@groundedpsychiatry.com
📞 Phone: 770-404-6653

We are happy to answer questions and provide clarity around expected costs.

  

Additional Information

For more information about your rights under the No Surprises Act, visit:
www.cms.gov/nosurprises

 

We believe in transparency, clarity, and informed care, so you can focus on healing, not surprises.

Effective as of June 19, 2024