Effective Date: July 1, 2026

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

Under the No Surprises Act, health care providers are required to give patients who don't have insurance, or who are not using insurance, an estimate of the expected charges 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 such as the initial consultation and any follow-up care.

  • You can ask Black Psychiatry LLC for a Good Faith Estimate before you schedule an item or service, or at any time during treatment.

  • If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill through the federal patient-provider dispute resolution process. You must start the dispute process within 120 days of the date on your original bill.

  • Make sure to save a copy or picture of your Good Faith Estimate.

How This Applies at Black Psychiatry

Black Psychiatry LLC accepts Cigna and Aetna, and also offers self-pay. The Good Faith Estimate applies to patients who are uninsured or who choose not to use their insurance. If that applies to you, we will provide a written Good Faith Estimate before your scheduled care, and you may request one at any time.

For More Information

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

To request a Good Faith Estimate, contact:

Black Psychiatry LLC
Provo, Utah
Phone: (801) 361-2255
Email: chris@black-psychiatry.com