Put the facility name, address, contact person, estimate date, expiration date, and quoted treatment period at the top of your notes. Then create five headings: included, excluded, payment timing, cancellations and refunds, and reasons for a revised estimate. Leave room for a sixth heading called unanswered. A blank should never silently become a yes.
Under included, ask for every charge covered by the estimate to be itemized. You can ask, “What exactly does this amount purchase?” and “Are evaluation, lodging, meals, routine supplies, medications, testing, outside appointments, and discharge or continuing-care planning included, excluded, or billed separately?” These are questions, not claims that any facility provides those items. Ask who bills for anything outside the estimate and whether you could receive a separate bill from another entity. Under excluded, request specific categories rather than accepting “incidentals may apply.” Ask for typical examples and the method used to calculate them, without assuming those costs will occur here. Keep medications in their own row because SAMHSA quality guidance supports asking whether medications are available when clinically appropriate, but availability and price must be confirmed with a
- Dated, written, itemized estimate and its expiration date
- Exact service period or unit covered by the quote
- Every included charge and every known exclusion listed separately,potential separate third-party bills and who sends them,deposit amount, due dates, and accepted payment methods,c
