Beargrass Pediatric Therapy, LLC

Notice Regarding No Surprises Act

This notice is to let you know about your protections from unexpected medical bills. You have the right to know the estimated medical costs prior to receiving care. This information is provided in a document but note that it is not a contract and you can choose to get care from other providers or a provider or facility in your health plan’s network, which may cost you less. You have the right to request assistance and ask questions regarding your estimate and your rights. Please keep a copy of these documents for your records. You are receiving this notice because this provider or facility is not in your health plan’s network. This means the provider or facility doesn’t have an agreement with your plan. Getting care from this provider or facility could cost you more. If your plan covers the item or service you are getting, federal law protects you from higher bills, when you get emergency care from out-of-network providers and facilities, or when an out-of-network provider treats you at an in-network hospital or ambulatory surgical center without your knowledge or consent. 

Ask your health care provider or patient advocate if you need help knowing if these protections apply to you. If you agree to self pay for services, you may pay more because: 

• You are giving up your protections under the law. You may owe the full costs billed for items and services received. 

• Your health plan might not count any of the amount you pay towards your deductible and out-of-pocket limit. Contact your health plan for more information. You have a choice of providers when receiving care. Before deciding whether to receive a service, you can contact your health plan to find an in-network provider or facility. If there is not one, your health plan might work out an agreement with this provider or facility, or another one. 

For more information, reach out to this office or visit www.cms.gov/nosuprises.com to learn more. 

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 health care will cost. Under federal law, health care providers need to give patients who don’t have certain types of health care coverage or who are not using certain types of health care coverage an estimate of their bill for health care items and services before those items or services are provided. 

You have the right to receive a Good Faith Estimate for the total expected cost of any health care items or services upon request or when scheduling such items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees. 

If you schedule a health care item or service at least 3 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 1 business day after scheduling. If you schedule a health care item or service at least 10 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after scheduling. You can also ask any health care provider or facility for a Good Faith Estimate before you schedule an item or service. If you do, make sure the health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after you ask. 

If you receive a bill that is at least $400 more for any provider or facility than your Good Faith Estimate from that provider or facility, you can dispute the bill. For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises/consumers