Good Faith Estimate

A Good Faith Estimate (GFE) is a written list of expected charges for a specific health care service or related services. Under the federal No Surprises Act, health care providers must give uninsured and self-pay patients a GFE before scheduled care.

The GFE helps you understand what you may pay before you receive services so you can plan and compare options.

You should receive a GFE if you are uninsured or if you choose not to submit a claim to your health insurer for the scheduled service (self-pay).

If you are using insurance, we verify coverage and explain expected out-of-pocket costs (copay, deductible, coinsurance) instead of or in addition to a GFE, depending on your plan.

Email: info@mindfulhealingmentalservices.com

Phone: +1 (347) 506-3881

Online: use the contact form at mindfulhealingmentalservices.com/contact and select "Insurance / fees question," or book through our online scheduler and note that you are self-pay or uninsured.

Please include your full name, phone number, email, the service you need (for example, initial psychiatric evaluation or follow-up visit), and your preferred appointment timeframe.

If your appointment is scheduled at least 3 business days in advance: within 1 business day of scheduling.

If your appointment is scheduled at least 10 business days in advance: within 3 business days of scheduling.

You may request a GFE at any time before services are provided.

Astrude Charles and our office staff respond to billing and estimate requests within 1 business day whenever possible.

Expected charges for the primary service (for example, psychiatric evaluation or medication management follow-up).

Reasonably expected related services that are part of the same scheduled course of care described in the estimate.

Provider and practice identification information.

A statement that the GFE is not a contract and actual charges may differ if additional services are medically necessary and agreed upon.

Information about your right to dispute a bill that exceeds the estimate by $400 or more.

Self-pay rates are provided during intake and in your GFE. Payment is typically due at the time of service unless other arrangements are made in advance.

If your financial situation changes before your visit, contact us so we can update your estimate or discuss options.

If your final bill is at least $400 more than your Good Faith Estimate, you have the right to dispute the bill.

Contact us first: info@mindfulhealingmentalservices.com or +1 (347) 506-3881.

If we cannot resolve the issue, you may initiate the federal independent dispute resolution process at cms.gov/nosurprises or by calling 1-800-985-3059.

Keep your GFE, billing statements, and any correspondence for your records.

For a full overview of the No Surprises Act and patient rights, see our No Surprises Act page.

Written requests or dispute correspondence may be mailed to: Mindful Healing Mental Health Services, 418 Broadway, Ste R, Albany, NY 12207.