Good Faith Estimate Notice
You have the right to receive a Good Faith Estimate explaining how much your medical care will cost.
Under the federal 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 evaluations and follow-up care.
- You can 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 schedule an item or service at least three business days in advance, make sure your provider gives you a Good Faith Estimate in writing at least one business day before your 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.
To request a Good Faith Estimate for care with Peacemark, contact us at hello@peacemarkpsychiatry.com.
This Good Faith Estimate is not a contract and does not obligate you to obtain any items or services from this provider. It shows only an estimate of expected charges; your actual charges may differ.
Last updated: August 3, 2026.