Your Right to a Good Faith Estimate

Under the law, health care providers need to give patients who don't have insurance or who are not using insurance an estimate of the bill 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.
• You can ask for a Good Faith Estimate before you schedule an item or service, or at any time.
• If you receive a bill that is at least $400 more than your Good Faith Estimate, you may be able to dispute the bill through the federal dispute process, if you qualify.
• Make sure to save a copy or picture of your Good Faith Estimate.

The timing depends on when you schedule: when a service is scheduled 3 to 9 business days ahead, the estimate is due within 1 business day after scheduling; when scheduled 10 or more business days ahead, within 3 business days after scheduling; and when you ask for one without scheduling, within 3 business days of your request.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 1-800-985-3059.

• $110 per hour-long session
• No deposit and no setup fee
• Payment is due at the time of service

This public rate notice is not your personal Good Faith Estimate. Your estimate is prepared in writing for you individually. We do not promise a set number of sessions or a particular result.

• Care through Grow Therapy: ask Grow Therapy through your Grow Therapy account or Grow Therapy support.
• Any other arrangement: contact Westside Counseling Ltd. at (513) 840-9005 or ervin@westsidecounseling.org.