Good Faith Estimate

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. 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.

What this means for you

• You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services.
• 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.

How Mamaya Health provides your estimate

Before your first scheduled appointment, your Mamaya care team will share a Good Faith Estimate that includes:

• The expected service (therapy, medication management).
• Service codes (e.g., 90791 for an initial assessment, 90837 for a 60-minute follow-up).
• Self-pay rates: $175 for an initial 60-minute intake; $125 for ongoing visits.
• Any expected additional services (e.g., medication management visits with a psychiatric NP).

If you’re using insurance, the Good Faith Estimate does not apply — your costs are determined by your plan. We verify your insurance benefits before your first session so you know your copay, coinsurance, and deductible up front.

Questions or concerns

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

For Mamaya-specific questions, contact us at support@mamayahealth.com.