Your Right to a Good Faith Estimate

You have the right to receive a Good Faith Estimate explaining how much your medical care will cost. Under the law, 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.

• You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment and hospital fees.
• Make sure your health care provider gives you a Good Faith Estimate in writing at least one 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.

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

Our self-pay fees

Service	Fee
Initial psychiatric evaluation60 to 90 minutes	$325
Follow-up visitMedication management, typically monthly then every three months	$185

For most self-pay patients, these fees are the Good Faith Estimate for our services. Lab work and GeneSight testing are billed separately by the laboratory or testing company, not by R3, and we discuss expected costs before ordering. A formal written Good Faith Estimate for your specific care is provided through the patient portal before your first visit and is available on request at any time.

Questions

R3 Women's Wellness, PLLC · (919) 473-6909 · tiirini@r3womenswellness.com. See also Insurance & Fees.