Open Grounds Inc.

Notice of Right to Receive a Good Faith Estimate of Expected Charges Under the No Surprises Act

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

Under the law, healthcare providers need to give patients who don’t have insurance or who selfpay for their services an estimate of the bill for medical items and services (including occupational therapy services).

You have the right to receive a Good Faith Estimate for the total expected cost of any nonemergency items or services, including occupational therapy services.

Ensure your healthcare provider gives you a Good Faith Estimate in writing at least one business day before your services begin. You can also ask your healthcare 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.