Your Right to a Good Faith Estimate

Under the federal No Surprises Act, you have the right to receive a "Good Faith Estimate" explaining how much your medical care will cost.

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Luna Integrative Psychiatry, PLLC is a private-pay practice. We do not contract with or bill any insurance plans, including Medicare, Medicaid, or commercial carriers. This means every patient receives a Good Faith Estimate as part of intake.

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What the law says

Under federal law, health care providers must 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 costs.

 

When you'll receive your Good Faith Estimate

• If you schedule a service at least 3 business days in advance: you'll receive your Good Faith Estimate within 1 business day of scheduling.

• If you schedule a service at least 10 business days in advance: you'll receive your Good Faith Estimate within 3 business days of scheduling.

• If you request a Good Faith Estimate without scheduling: you'll receive it within 3 business days of your request.

At Luna, your Good Faith Estimate is delivered through our patient portal as part of your intake paperwork after appointment confirmation. A copy is retained in your medical record for at least six years.

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If your bill is higher than your estimate

If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. You may:

• Contact Luna Integrative Psychiatry to discuss the difference and request that the bill be updated.

• Initiate a federal Patient-Provider Dispute Resolution process within 120 calendar days of receiving the bill.

Make sure to save a copy of your Good Faith Estimate.

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For more information

For questions about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 1-800-985-3059.

To request a Good Faith Estimate, contact Luna Integrative Psychiatry at 217-403-9459.

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