Good Faith Estimate for Health Care Items and Services
Good Faith Estimate for Psychiatric Treatment Services
As a patient of Sunny Skies Healthcare, you are entitled to receive a Good Faith Estimate for your expected psychiatric treatment services.
This estimate outlines the anticipated costs based on information available at the time the estimate was created.
Please note:
This estimate is not a guarantee of the number of sessions you will need, as the required treatment plan will be determined after your Initial Evaluation. You and your provider at Sunny Skies Healthcare will decide on the appropriate course of action based on your individual circumstances.
You may choose to discontinue your sessions at any time.
Estimate of Charges
| Service | Cost Range |
|---|---|
| Initial Evaluation | $750.00 |
| Psychotherapy + Medication Management (Monthly/Bi-Weekly/Weekly) | $4,800.00 to $20,800.00 |
| Straightforward Medication Management (Monthly/Bi-Weekly/Weekly) | $2,400.00 to $10,400.00 |
Important Disclaimers:
This Good Faith Estimate is not a contract and does not obligate you to receive any services.
The estimate is based on information available at the time of creation, and it does not include any potential additional services or charges that may arise during treatment. If additional services are needed, separate Good Faith Estimates will be provided.
If your actual charges exceed this estimate, you have the right to dispute the bill and may seek resolution through the U.S. Department of Health and Human Services (HHS).
Dispute Resolution Process:
If you are billed more than the amount shown in this estimate, you can dispute the charges within 120 days of receiving the bill.
There is a $25 fee to initiate the dispute process. You can learn more and start the process by visiting cms.gov/nosurprises or calling HHS at 1-800-985-3059.
Important Notes:
Keep a copy or a picture of this estimate for your records.
Existing patients may have an established diagnosis and treatment plan, while new patients may not. In these cases, a reasonable estimate based on available information will be provided.
Please feel free to contact Sunny Skies Healthcare for any questions regarding your treatment plan, payment options, or this Good Faith Estimate.