You have the right to receive a “Good Faith Estimate” explaining how much your health care will cost.
Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.
- You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
- Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
- If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
- Make sure to save a copy or picture of your Good Faith Estimate.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 1-800-985-3059.
Who this applies to
This right applies to you if you do not have health insurance, or if you have insurance but choose not to use it for your care at Strata Outpatient. If you are using your insurance, your plan’s explanation of benefits describes what you will owe, and we will walk you through it during admissions.
What the estimate covers
Your Good Faith Estimate lists the services we reasonably expect to provide for your care and the cost of each. For most people at Strata that means some combination of an initial assessment, individual therapy sessions, Intensive Outpatient Program days, and psychiatric evaluation and medication management visits, over the period of care we expect at the outset. The Intensive Outpatient Program is charged per day of programming; every other service is charged per visit. The estimate shows the rate for each, how many we expect, and the total, so you can see how the number is built.
The estimate is a good-faith prediction, not a bill and not a guarantee. If your care changes — more sessions, fewer, a different level of care — the cost will change with it, and we will give you an updated estimate before that happens.
How to get one
- When you schedule. If you tell us you will be paying for care yourself, we will give you a Good Faith Estimate in writing without you having to ask — within 1 business day if your first appointment is 3 to 9 days away, and within 3 business days if it is 10 or more days away.
- Before you schedule. You can ask for an estimate at any time, even if you are only considering care. We will provide it within 3 business days of your request.
- How to ask. Call (858) 567-4246 or email contact@strataoutpatient.com. Tell us what services you are interested in so the estimate can be specific.
You can have the estimate on paper or electronically, whichever you prefer. Keep a copy.
If your bill is higher than the estimate
If you are billed at least $400 more than your Good Faith Estimate, you can use the federal patient–provider dispute resolution process. An independent reviewer looks at the estimate and the bill and decides what you owe. To use it, you must start the dispute within 120 calendar days of the date on the bill, and there is a small administrative fee, which is refunded to you if the reviewer decides in your favor. Starting a dispute does not affect your care with us, and we will not send the disputed amount to collections while it is under review.
Before going that route, call us. Most differences between an estimate and a bill have an explanation, and we would rather sort it out with you directly.
Details of the dispute process, and the form to start one, are at www.cms.gov/nosurprises, or by phone at 1-800-985-3059.
Questions
Strata Outpatient
11230 Sorrento Valley Road, Suite 225
San Diego, CA 92121
(858) 567-4246
contact@strataoutpatient.com