Tentie Psychiatry, LLC is private pay only
This practice is not paneled with any insurance carrier. All services are the financial responsibility of the patient. Under Section 2799B-6 of the Public Health Service Act, you have the right to receive a Good Faith Estimate of expected charges — orally and in writing — when you schedule care or upon request.
| Service | Length | Fee |
|---|---|---|
| Initial psychiatric evaluation (adults 18+) | Up to 90 min | [$XXX] |
| Additional initial evaluation session, if warranted | Up to 60 min | [$XXX] |
| Routine medication follow-up | Approx. 25 min | [$XXX] |
| Extended follow-up | Approx. 40 min | [$XXX] |
| Extended follow-up | Approx. 55 min | [$XXX] |
| Extended telephone call (over 10 minutes) | Per 15 min | [$XX] |
| Extended or complex forms, letters and reports | Per document | Up to [$XXX] |
| Coordination of care (over 15 minutes) | Per 15 min | [$XX] |
| Copying of records | First 20 pages | [$XX] |
| Copying of records — additional pages | Per page | [$0.XX] |
What this estimate means
- This Good Faith Estimate shows the costs of items and services reasonably expected for your healthcare needs, based on information known at the time it was created.
- It does not include unknown or unexpected costs that may arise during treatment, nor laboratory work, imaging, medications, or services billed by any other clinician.
- If you are billed for substantially more than this Good Faith Estimate, you have the right to dispute the bill.
- Keep a copy of your Good Faith Estimate.
If you are billed more than your estimate
Contact the office first at [PHONE] so the difference can be reviewed and discussed.
You may also start a patient-provider dispute resolution process with the U.S. Department of Health and Human Services. If you choose to do so, you must start it within 120 calendar days of the date on the original bill. There is a $25 fee to use the dispute process. If the agency reviewing the dispute agrees with you, you pay the price on this Good Faith Estimate; if it agrees with the provider, you pay the higher amount.
To learn more and to get the form, visit www.cms.gov/nosurprises or call 1-800-985-3059.
Balance billing and surprise bills
When you get emergency care, or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, federal law protects you from surprise billing and balance billing. You are only responsible for your share of the cost, and you are never required to give up that protection.
Tentie Psychiatry provides scheduled outpatient psychiatric care only. It is not a hospital, an emergency facility or an ambulatory surgical center, and it does not participate in any insurance network. Because you choose this practice knowingly and pay directly, the surprise-billing scenarios above do not arise here — the fees on this page are the fees you will be charged.
Getting your copy
A signed copy of the Good Faith Estimate is provided when you schedule, and is listed on the forms page alongside the other documents you will receive.