You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost.

Under the law, health care providers must provide 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 cost of services. Please let your provider know if you would like one.

• Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service. 
• If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. 
• Make sure to save a copy or picture of your Good Faith Estimate. 

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

Name of company

Providence South Counseling Group, PLLC

Registered office

110 Matthews Station Street, Suite 2H, Matthews, NC 28105

Contact details

704.776.5635

admin@providencesouthcounseling.com