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Good Faith Estimate 

Provider Name: Erin Eising LMSW

NPI: 1023367448

Under Section 2799B-6 of the Public Health Service Act, health care providers/facilities are required to provide a good faith estimate of expected charges for items and services to individuals who do not have health insurance coverage or who are not seeking to file a claim with their coverage, both orally and in writing upon request or at the time of scheduling health care service—Therapy Intake.

Live your Joy Counseling PLLC, Grand Rapids, MI 

90791 / $150 initial intake assessment 

90837 / $120 60 min session 

Disclaimer:

This Good Faith Estimate shows the costs of items and services that are reasonably expected for your health care needs for an item or service. The estimate is based on information known at the time the estimate was created. The Good Faith Estimate does not include any unknown or unexpected costs that may arise during treatment. You could be charged more if complications or special circumstances occur. If this happens, federal law allows you to dispute (appeal) the bill. If you are billed for more than this Good Faith Estimate, you have the right to dispute the bill. You may start a dispute resolution process with the U.S. Department of Health and Human Services (HHS). If you choose to use the dispute resolution process, you must start the dispute process within 120 calendar days of the date on the original bill. There is a $25 fee to use the dispute process. If the agency reviewing your dispute agrees with you, you will have to pay the price on this Good Faith Estimate. If the agency disagrees with you and agrees with the health care provider or facility, you will have to pay the higher amount. To learn more and get a form to start the process, go to www.cms.gov/nosurprises or call HHS at 1-877-696-6775. For questions or more information about your right to a Good Faith Estimate or the dispute process, visit www.cms.gov/nosurprises or call HHS at 1-877-696-6775.