Good Faith Estimate

OXIDIAN HEALTH, LLC

YOUR RIGHT TO A GOOD FAITH ESTIMATE

Effective Date: 6/15/2026                 

You have the right to receive a Good Faith Estimate explaining how much your care will cost.

Under the federal No Surprises Act, health care providers must give patients who are uninsured or who are not using insurance an estimate of the expected charges for services before those services are provided.

  • You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency services, including psychiatric evaluation and medication-management visits.

  • If you schedule a non-emergency service, we will give you a Good Faith Estimate in writing within the timeframe required by law (generally at least 1 business day before your service). You can also ask Oxidian Health for a Good Faith Estimate before you schedule, or at any time during treatment.

  • Your Good Faith Estimate will list the expected charges for the services we anticipate providing. For ongoing care such as medication management, it may cover the expected course of treatment.

  • A Good Faith Estimate is not a bill. Your actual charges may differ depending on your clinical needs and the services actually provided. If a visit includes additional services — for example, psychotherapy along with medication management — the charge may change.

  • Make sure to save a copy or picture of your Good Faith Estimate.

IF YOU ARE USING INSURANCE

If you have an insurance plan that Oxidian Health accepts through Headway and you are using it, the amount you owe is determined by your plan (such as your copayment, coinsurance, and deductible), and the Good Faith Estimate process for uninsured and self-pay patients does not apply to those visits.

YOUR RIGHT TO DISPUTE A BILL

If you receive a bill that is at least $400 more than your Good Faith Estimate for any provider, you have the right to dispute the bill through the federal patient-provider dispute resolution process. You must start the dispute process within 120 days of the date on your bill.

For more information about your right to a Good Faith Estimate, visit https://www.cms.gov/nosurprises or call 1-800-985-3059. To request a Good Faith Estimate, contact Oxidian Health, LLC at (908) 545-9692 or info@oxidianhealth.com.