Good Faith Estimate

What your care here is expected to cost, and your right to receive that in writing before you start.

Your right

You have the right to a Good Faith Estimate

If you do not have health insurance, or you have insurance but choose not to use it for your care here, you have the right to receive a Good Faith Estimate of what your treatment is expected to cost.

You can ask for an estimate at any time, including before you schedule anything and before you are a patient here. Just contact us and we will send one.

You will also receive one without having to ask. If you are not using insurance for your care and you book your initial psychiatric evaluation at least three business days ahead, your estimate arrives with your intake paperwork in the client portal, shortly after you book. If you book on shorter notice than that, ask and we will send one.

The introductory 15-minute consultation is a separate conversation to see whether this practice is a good fit for you. There is no charge for it, so it does not come with an estimate. Your estimate covers the initial evaluation and the follow-up care expected after it.

You can have your estimate electronically or on paper, whichever you prefer.

Keep your estimate. You may want it later to compare against a bill.

Current fees

What care costs

The charge for a visit does not change based on which billing code is reported. Your estimate lists the codes that may apply, so you can compare it against any bill or superbill you receive.

Your estimate will also show how many follow-up visits are expected over the period it covers. Visit frequency is a clinical decision we make together and may change; you can request an updated estimate at any time.

Scope

What an estimate does not include

An estimate covers only services provided by this practice. It does not include:

• Prescription medications, which are billed by your pharmacy
• Laboratory tests, which are billed by the laboratory
• Care from any other provider, including therapists, primary care physicians, or emergency services
• Missed appointment and late cancellation fees, or fees for letters and documentation, which depend on your own choices and cannot be predicted in advance

If a bill is higher

If you are billed more than your estimate

Start by contacting the practice. We can review the bill with you, correct it if something is wrong, discuss the amount, or talk about whether financial assistance is available.

You may also start a dispute resolution process with the U.S. Department of Health and Human Services. You must start that dispute within 120 calendar days of the date on the original bill, and there is a $25 fee to use the process.

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

Using insurance

If you are using insurance

A Good Faith Estimate applies when you are not using insurance for your care. If you are using an insurance plan this practice is in network with, your costs are determined by your plan’s benefits rather than by an estimate, and you can contact your plan for what you will owe.

If this practice is out of network for your plan, you pay the rates above directly. A superbill is available on request so you can seek out-of-network reimbursement, though the amount reimbursed is determined entirely by your plan.

Getting one

How to request an estimate

Contact the practice at (562) 239-9980 or hello@peacemarkpsychiatry.com. There is no charge for an estimate, and asking for one does not commit you to scheduling anything.

A Good Faith Estimate is not a contract and does not require you to obtain the services listed. A paper copy of this page or of your estimate is available at no charge on request, as is a copy in another language or in an accessible format.

Last updated: August 29, 2026.

Back to home