Use direct language: “Please send me a dated, itemized estimate in writing. For each line, identify the service, rate, quantity assumed, subtotal, required deposit, payment due date, and whether the amount is firm or can change.” Then ask for separate lines for assessments, testing, medications, professional services, supplies, and any other category the facility may charge. This list is a request for disclosure, not a claim that any particular item is offered or required.
Ask the facility to state the assumed start date and duration used only for pricing. A clinical plan and actual duration may differ, so do not treat the estimate’s assumed number of days as a recommendation or promise. If the estimate uses a daily rate, ask how partial days, an earlier departure, or an extended stay would be calculated. If it uses a package price, ask exactly what begins and ends the package and whether unused services are refundable.
- Facility’s legal name and treatment address
- Estimate date, expiration date, and preparer’s name or department
- Each charge, its pricing unit, assumed quantity, and subtotal in dollars. If your requested JSON renderer cannot display a table, keep one row per charge in your notes instead of a
