Good Faith Estimate Notice

Under the federal No Surprises Act, patients who are uninsured or who choose not to use insurance may have the right to receive a written Good Faith Estimate of expected charges for scheduled healthcare services.

What the Estimate May Include

• ✓ Initial psychiatric evaluation.
• ✓ Follow-up appointments.
• ✓ Medication-management visits.
• ✓ Psychological or ADHD-related assessment services, when offered.
• ✓ Telehealth or in-person visits.
• ✓ Other reasonably anticipated services provided by Sprout Anew.

The estimate is based on information known when it is prepared. Actual treatment needs may change after clinical evaluation.

When You May Request an Estimate

You may request an estimate before scheduling care. When an appointment is scheduled sufficiently in advance, Sprout Anew will provide the estimate within the timeframe required by applicable law.

Important Limitations

A Good Faith Estimate is not a contract and does not require you to receive the listed services. Actual charges may differ when your treatment needs change, additional services are requested or clinically necessary, appointments are added or changed, information supplied before treatment was incomplete, or another provider or facility separately bills for services.

Disputing a Bill

When a bill is at least $400 more than the Good Faith Estimate from a particular provider or facility, you may be eligible to use the federal patient-provider dispute-resolution process. Keep a copy of your Good Faith Estimate and all related billing documents.

Requesting an Estimate