Your right to a Good Faith Estimate
Under the No Surprises Act, patients who are not using insurance have the right to receive a written Good Faith Estimate of expected charges before care begins. Mental Equilibrium is a self-pay, out-of-network practice, so this right applies to every patient.
What the estimate covers
- The expected cost of the visit or series of visits being scheduled.
- Published fees: initial evaluation (90 minutes) $545; follow-up (45 minutes) $395; follow-up (25 minutes) $295; the first 15-minute phone call is free.
- Laboratory, genetic, or cognitive testing is billed by the outside laboratory, not by this practice, and is not included unless stated.
When it is provided
- In writing, at least one business day before a visit scheduled three or more business days ahead, and at least three business days before a visit scheduled ten or more days ahead.
- On request, at any time, before scheduling.
If the bill is higher than the estimate
If a bill is at least $400 more than the Good Faith Estimate, you may dispute it through the federal patient-provider dispute resolution process. Keep a copy of the estimate. Information and the dispute form are at www.cms.gov/nosurprises, or call 1-800-985-3059.
How to request one
Email alokdube@mentalequilibrium.com or ask during the free 15-minute call. A written estimate is sent through the patient portal.
Mental Equilibrium, 1430 S Dixie Hwy, Ste 105 1114, Coral Gables, FL 33146. This notice follows the CMS model notice for the No Surprises Act (45 CFR 149.610).