LA Integrative Psychiatry
1612 W Olive Ave Suite 200, Burbank, CA 91506
Phone: (747) 777-7047
Effective date: October 10, 2026. Last updated: October 10, 2026.
Your right to a Good Faith Estimate
You have the right to receive a “Good Faith Estimate” explaining how much your health care will cost.
Under the law, health care providers need to give patients who do not have insurance, or who are not using insurance, an estimate of the expected charges for medical items and services.
- You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
- Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
- If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
- Make sure to save a copy or picture of your Good Faith Estimate.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 1-800-985-3059.
How it works at LA Integrative Psychiatry
- Who receives one. Any patient who is uninsured, or who chooses not to use insurance for a visit, receives a written Good Faith Estimate. Patients using insurance receive one on request.
- Our standard self-pay rates. Initial evaluation $400. Follow-up visit $200. ADHD testing for patients under 18 is self-pay at the same rates. Your estimate lists the services we expect to provide and the expected charge for each.
- When you receive it. If you ask for an estimate, we provide it within 3 business days. If you schedule a visit 3 to 9 business days ahead, we provide the estimate within 1 business day after scheduling. If you schedule 10 or more business days ahead, we provide it within 3 business days after scheduling.
- How you receive it. In writing, on paper or through the patient portal, in the format you prefer. We keep a copy in your record.
- What it is not. An estimate is not a bill and not a contract. Your actual charges may differ if your care changes, for example if your provider recommends a service that was not expected.
- If your bill is higher. If a bill from us is at least $400 more than the estimate, you may ask us to explain the difference, and you may start the federal patient-provider dispute resolution process within 120 calendar days of the bill date. The process has an administrative fee set by the federal government (currently $25). Starting a dispute does not affect your care.
- How to ask. Call (747) 777-7047, ask at the front desk, or request it when you book online.
Our full payment, cancellation, and billing terms are on our Patient Policies page.