No Surprises Act & Good Faith Estimate
Last Updated: August 15, 2026
Your Right to a Good Faith Estimate. Under the No Surprises Act, you have the right to receive a Good Faith Estimate explaining the expected cost of your health care services if you do not have health insurance or if you choose not to use your health insurance to pay for your care.
At Pink Horizon Psychiatry, we are committed to providing clear information about the expected costs of services and to complying with applicable federal requirements regarding Good Faith Estimates.
Who Can Receive a Good Faith Estimate?
You may be entitled to a Good Faith Estimate if you:
- Do not have health insurance; or
- Have health insurance but choose not to use your insurance to pay for your care.
A Good Faith Estimate is an estimate of the expected charges for scheduled health care services. It is not a bill and does not guarantee the final amount you will owe.
When Will I Receive a Good Faith Estimate?
If you are uninsured or self-pay, Pink Horizon Psychiatry will provide a Good Faith Estimate when required by applicable law.
Generally, you may receive a Good Faith Estimate when:
- You schedule a health care service at least 3 business days in advance;
- You request a Good Faith Estimate before scheduling care; or
- You ask about the expected cost of a health care service.
Federal requirements establish specific timing for providing estimates depending on how far in advance services are scheduled.
The Good Faith Estimate will generally include the expected charges for the health care items and services that can reasonably be anticipated at the time the estimate is prepared.
What Is Included in a Good Faith Estimate?
A Good Faith Estimate may include an itemized description of expected health care services and the expected charges associated with those services.
Because a Good Faith Estimate is prepared based on information reasonably known at the time it is created, it may not include services that were not reasonably anticipated when the estimate was prepared.
If services are provided by another health care provider or facility, you may need to obtain a separate Good Faith Estimate from that provider or facility.
Your Right to Request an Estimate
You do not have to wait until you schedule an appointment to ask about a Good Faith Estimate.
If you are uninsured or intend to self-pay, you may request an estimate of expected charges before receiving services.
To request a Good Faith Estimate, please contact:
Please do not send confidential medical information, diagnoses, treatment information, or other protected health information through ordinary email when requesting a Good Faith Estimate.
If Your Bill Is Substantially Higher Than Your Good Faith Estimate
You should keep your Good Faith Estimate and compare it with the bill you receive.
If your final bill from Pink Horizon Psychiatry is at least $400 more than your Good Faith Estimate from Pink Horizon Psychiatry, you may have the right to dispute the bill through the federal Patient-Provider Dispute Resolution process.
The federal dispute process has specific eligibility requirements and procedures.
For more information about the federal dispute resolution process, visit the Centers for Medicare & Medicaid Services (CMS) No Surprises Act resources.
Questions About Your Bill?
If you have questions about a bill or Good Faith Estimate, please contact Pink Horizon Psychiatry before sending payment.
We are committed to helping patients understand the expected costs of their care.
Important Information
A Good Faith Estimate is based on the information reasonably available when the estimate is prepared. It is not a contract, insurance determination, or guarantee of the final amount you will owe.
The No Surprises Act’s Good Faith Estimate requirements generally apply to uninsured and self-pay individuals. Other provisions of the No Surprises Act may apply in different circumstances, including certain out-of-network services.
For additional information about your rights under the No Surprises Act, visit the Centers for Medicare & Medicaid Services (CMS) website.