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MODEL \"NO SURPRISES ACT\" GOOD FAITH ESTIMATE For Clinical Social WorkersNote: Place Good Faith Estimates on provider letterhead. Adapt the language below as necessary to meet your needs. This includes
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The No Surprises Act is a federal law aimed at protecting patients from unexpected medical bills, particularly in situations where they receive care from out-of-network providers without their knowledge.
Healthcare providers and facilities, as well as insured group health plans, are required to file under the No Surprises Act.
To fill out the No Surprises Act forms, providers need to gather necessary patient information, detail the services provided, and ensure compliance with the regulations stipulated under the act.
The purpose of the No Surprises Act is to protect patients from unexpected out-of-network medical billing and to promote transparency in healthcare costs.
Providers must report the patient's insurance information, the services rendered, the cost estimates, and disclosures regarding out-of-network status.
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