Your Right to Receive a Good Faith Estimate of Expected Charges

Under federal law, healthcare providers must generally give clients who do not have insurance—or who choose not to use insurance—an estimate of the expected cost of their healthcare services.

This is known as a Good Faith Estimate.

Who May Receive an Estimate?

You may request a Good Faith Estimate if:

• You do not have health insurance; or

• You have health insurance but do not plan to use it to pay for your services.

You may request an estimate before scheduling services or receive one after scheduling eligible services.

When Will I Receive My Estimate?

If you schedule services:

• At least 3 but fewer than 10 business days in advance: The estimate will generally be provided within 1 business day after scheduling.

• At least 10 business days in advance: The estimate will generally be provided within 3 business days after scheduling.

• Before scheduling: If you request an estimate without scheduling services, it will generally be provided within 3 business days of your request.

A Good Faith Estimate is not required when a service is scheduled fewer than three business days in advance.

What Will the Estimate Include?

Your written Good Faith Estimate will explain the expected charges for the services reasonably anticipated as part of your care.

The estimate is based on information known at the time it is created. Actual services or costs may change if your needs, treatment plan, session frequency, or length of treatment changes.

A Good Faith Estimate is not a contract and does not require you to receive services from Healing Path Counseling Services, LLC.

If Your Bill Is Higher Than the Estimate

Keep a copy of your Good Faith Estimate and compare it with future bills.

If a bill from a provider or facility is $400 or more above that provider’s or facility’s Good Faith Estimate, you may be eligible to use the federal patient-provider dispute-resolution process.

For information about your rights or the dispute process, visit CMS.gov/NoSurprises or call the No Surprises Help Desk at 1-800-985-3059.

Request an Estimate

To request a written Good Faith Estimate, contact:

Healing Path Counseling Services, LLC
350 E. Michigan Avenue, Suite 516
Kalamazoo, MI 49007

Phone: 269-205-3073
Email: ashleydecou@HPCServices.org

Please do not include sensitive, confidential, or emergency information in an ordinary email.