If you are paying for our services out-of-pocket, 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 clients who are “self-pay,” defined as those that do not have healthcare insurance or who choose not to use their healthcare insurance for our services, an estimate of their bill for health care items and services before those items or services are provided.
Iroko Psychiatry complies with the federal No Surprises Act and all applicable Texas state laws governing self-pay patients and outpatient mental health services. The right to receive a Good Faith Estimate applies to individuals receiving services in Texas who are uninsured or who elect not to submit claims to their health insurance plan, including services delivered via telepsychiatry.
Texas residents receiving services from Iroko Psychiatry may request a Good Faith Estimate in accordance with federal law. Nothing in this notice limits or replaces additional protections that may be available under Texas law.
Iroko Psychiatry provides telepsychiatry services to patients located in multiple U.S. states, consistent with applicable federal regulations and state-specific professional licensing requirements. The Good Faith Estimate protections described in this notice apply regardless of whether services are delivered in person or via telehealth, provided the patient is considered self-pay under federal law.
Because healthcare pricing, scope of practice regulations, and patient protections may vary by state, Good Faith Estimates reflect anticipated charges based on the patient’s location at the time services are rendered. Estimates are not guarantees of final charges but are provided in good faith based on the information reasonably available at the time.
You have the right to receive a Good Faith Estimate for the total expected cost of your care from Iroko Psychiatry upon request or when scheduling an appointment. The Good Faith Estimate includes related costs like medical tests, prescription drugs, equipment, and other fees.
If you schedule an appointment at least three business days in advance, Iroko Psychiatry will provide you with a Good Faith Estimate in writing within one business day after scheduling. If you schedule an appointment at least ten business days in advance, Iroko Psychiatry will provide you with a Good Faith Estimate in writing within three business days after scheduling. You can also ask Iroko Psychiatry for a Good Faith Estimate before you schedule an appointment, which we will provide to you within three business days of your request.
If you receive a bill that is at least $400 more than our 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/consumers, email FederalPPDRQuestions@cms.hhs.gov, or call 1-800-985-3059.
