Your right to a Good Faith Estimate

A Good Faith Estimate explains the expected charges for your health care. Under the No Surprises Act, patients who do not have certain types of health coverage, or who are not using certain types of coverage for their care, have a right to an estimate before care is provided.

You may request an estimate before scheduling. For eligible uninsured or self-pay patients, the written estimate is due:

• Within 1 business day after scheduling care 3 to 9 business days in advance.
• Within 3 business days after scheduling care at least 10 business days in advance.
• Within 3 business days after requesting an estimate before scheduling.

The estimate describes reasonably expected services and charges. It is not a bill or a commitment to receive care. If other providers or facilities are involved, ask them for their own estimates. Unanticipated care may not appear in the estimate.

If your bill is higher than your estimate

If a provider or facility bills you at least $400 more than its Good Faith Estimate, you may use the federal patient-provider dispute resolution process. Start the dispute within 120 calendar days of receiving the initial bill. Keep a copy of your estimate and bill.

Questions and requests

Contact Mountain States Psychiatry at (970) 602-4222 or billing@mountainstatespsychiatry.com. Please do not send diagnoses, medical records, or other sensitive health information by ordinary email. Ask how to provide any needed details through an approved channel.

Learn more about Good Faith Estimates and medical bill rights at CMS

This page explains your rights. It is not your personal cost estimate. The appointment fees listed elsewhere on this website do not replace a written estimate prepared for your care.