Good Faith Estimate

YOUR RIGHT TO A GOOD FAITH ESTIMATE

Under the No Surprises Act (effective January 1, 2022),

you have the right to receive a Good Faith Estimate

explaining how much your medical care will cost.

Under the law, healthcare providers need to give

patients who don't have insurance, or who are not

using insurance, an estimate of the expected charges

for medical services, including psychiatric services.

You have the right to receive a Good Faith Estimate

for the total expected cost of any non-emergency

healthcare services before you schedule a service.

If you receive a bill that is at least $400 more than

your Good Faith Estimate, you can dispute the bill.

For questions or more information about your right to

a Good Faith Estimate, visit www.cms.gov/nosurprises.

OUR CURRENT RATES

Free Introductory Call (15 minutes): $0

Initial Consultation & Evaluation (75 minutes): $950

Medication Management Follow-Up (30 minutes): $450

Psychotherapy +/- Medication Management (45 minutes): $500

INSURANCE & PAYMENT

Harbor Wellness Psychiatry, PLLC is a self-pay practice

and does not accept insurance directly. Upon request,

we can provide you with a superbill (itemized receipt)

that you may submit to your insurance company for

potential out-of-network reimbursement. HSA and FSA

payments are accepted.

TO REQUEST A GOOD FAITH ESTIMATE

Please contact us before scheduling your appointment:

Harbor Wellness Psychiatry, PLLC

Phone: (917) 267-9120

Email: contact@harborwellnesspsychiatry.com