Patient rights
Good Faith Estimate
Under the federal No Surprises Act, you have the right to a Good Faith Estimate of expected charges before scheduled care.
Your right to a Good Faith Estimate
Effective January 1, 2022, the federal No Surprises Act gives uninsured and self-pay patients the right to receive a written Good Faith Estimate of expected charges before scheduled medical services.
If you are paying out of pocket (no insurance, or you choose not to use yours), you can ask for a written estimate from any provider. We provide one proactively to all self-pay patients before scheduling, and to any insured patient who asks.
Standard self-pay rates
| Service | Self-pay rate |
|---|---|
| Initial 60-minute psychiatric evaluation | $300 |
| Follow-up medication management (20 min) | $175 |
| Follow-up med management with brief therapy | $235 |
| Standalone therapy (50–60 min) | $190 |
Rates current as of April 2026 and subject to change. The above is an estimate; your actual cost depends on the services delivered.
If your final bill exceeds the estimate
If the actual amount you are billed for a service is at least $400 more than the Good Faith Estimate (and you don’t have insurance covering it), you have the right to dispute the charges through the federal Patient-Provider Dispute Resolution process. cms.gov/nosurprises
Requesting a written estimate
Contact us at (860) 385-6547 or info@northlinepsych.com. We provide written estimates within 1 business day.