Effective Date: 02/20/2026

Under the No Surprises Act, healthcare providers are required to provide uninsured and self-pay patients with a Good Faith Estimate of expected charges for medical services. 

Your Right to a Good Faith Estimate

You have the right to receive a Good Faith Estimate explaining the expected cost of your healthcare services.

This applies if you:

• do not have insurance, or

• choose not to use your insurance, or

• are considered self-pay for services

What the Estimate Includes

The Good Faith Estimate will include reasonably expected charges for:

• psychiatric evaluation and intake services

• follow-up appointments

• medication management services

• other related services reasonably expected as part of care

The estimate is based on information known at the time it is created.

When You Will Receive an Estimate

You will receive a Good Faith Estimate:

• when you schedule services, or

• upon request before scheduling care.

If services are scheduled at least 3 business days in advance, the estimate will be provided within required federal timeframes.

If Your Final Bill Is Higher Than Expected

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

You may initiate a dispute resolution process through the U.S. Department of Health & Human Services (HHS).

Save a Copy

You are encouraged to save or print a copy of your Good Faith Estimate for your records.

Questions or Requests

To request a Good Faith Estimate or ask questions:

Solidarity Mental Health, PLLC

450 Alaskan Way S Suite 200
Seattle, Washington 98104
contact@solidaritymentalhealth.com