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

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. 

• 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 the Colorado Division of Insurance at  303-894-7490 or 1-800-930-3745. 

Discrimination is Against the Law

Brave Embodiment Counseling complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex (consistent with the scope of sex discrimination described at 45 CFR § 92.101(a)(2)) or sex, including sex characteristics, including intersex traits; pregnancy or related conditions; sexual orientation; gender identity, and sex stereotypes). 1] Brave Embodiment Counseling does not exclude people or treat them less favorably because of race, color, national origin, age, disability, or sex.

  • Provides people with disabilities reasonable modifications and free appropriate auxiliary aids and services to communicate effectively with us, such as:

    • Qualified sign language interpreters

    • Written information in other formats (large print, audio, accessible electronic formats, other formats).

  • Provides free language assistance services to people whose primary language is not English, which may include:

    • Qualified interpreters

    • Information written in other languages

If you need reasonable modifications, appropriate auxiliary aids and services, or language assistance services, contact Kimberly Massale

If you believe that Brave Embodiment Counseling has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with: Kimberly Massale, LPC , 2590 Welton Street, Suite 200-1005, Denver, CO 80205, 720-923-3033, info@bravecounseling.com. You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, Kimberly Massale, LPC, is available to help you.

You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:

U.S. Department of Health and Human Services

200 Independence Avenue, SW

Room 509F, HHH Building

Washington, D.C. 20201

1-800-368-1019, 800-537-7697 (TDD)

Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.

This notice is available at Brave Embodiment Counseling’s website: https://www.bravecounseling.com/good-faith-estimate-non-discrimination.