Your Right to a Good Faith Estimate

Public Information Only

Viewing or downloading this notice, or requesting or receiving a Good Faith Estimate (GFE), does not by itself establish a clinician-client relationship, mean that OpenGate has accepted an individual for services, or schedule an appointment. A GFE is not a contract and does not require you to obtain care from OpenGate. Availability and acceptance for services are determined separately.

Who Has a Right to a Good Faith Estimate

Under federal No Surprises Act rules, people who are uninsured or self-pay under federal definitions generally have a right to a written GFE of expected charges when they request one or when qualifying care is scheduled at least 3 business days in advance. Generally, this includes a person who does not have applicable health coverage for the services, or who has group or individual health insurance or Federal Employees Health Benefits (FEHB) coverage but does not seek to have a claim submitted to that coverage for the services. Federal health care program enrollees, such as people enrolled in Medicare, Medicaid, or TRICARE, are treated differently under these federal GFE rules.

When the Estimate Is Provided

• Scheduled 3-9 business days in advance: within 1 business day after scheduling.
• Scheduled 10 or more business days in advance: within 3 business days after scheduling.
• Requested before or without scheduling: within 3 business days after the request. If the service is later scheduled, a new scheduled estimate is provided within the applicable timeframe.

What an Individualized GFE Includes

The individualized written estimate describes the primary item or service, items or services reasonably expected to be furnished by OpenGate in connection with it, applicable service codes and provider identifiers when required, expected charges, and other required information. If recurring primary items or services are reasonably expected, one GFE may describe the timeframe, frequency, total number, and expected charges for a period that does not exceed 12 months.

If the Bill Is Substantially Higher

If OpenGate later bills at least $400 more than OpenGate's total expected charges on the applicable GFE, you may be eligible for the federal patient-provider dispute resolution process. A request generally must be started within 120 calendar days after the initial bill. Starting a dispute will not adversely affect the quality of your care.

Federal information and help: CMS Medical Bill Rights - https://www.cms.gov/medical-bill-rights | No Surprises Help Desk: 1-800-985-3059.

How to Request an Estimate from OpenGate

You do not need to complete or return a public website form. Contact OpenGate to request a GFE or to ask whether GFE rights apply to your situation. OpenGate will provide any GFE required by federal law based on the information reasonably available at the time. This public notice is available in English and Spanish. Contact OpenGate if an accessible format is needed.

OpenGate Counseling & Consulting | (307) 315-8655 | damon@damonlaird.com | damonlaird.com. Do not send sensitive clinical, substance-use, or legal information by ordinary email or text; ask for secure instructions if sensitive information is needed.