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Davis Counseling & Play Therapy Center, PLLCGood Faith Estimate for Health Care Items and ServicesUnder the No Surprises Act, Effective January 1, 2022 [H.R. 133]Consent, Notice, & Good Faith EstimateIMPORTANT:
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How to fill out no surprises act

01
Obtain a copy of the No Surprises Act and read it thoroughly to understand your rights and obligations.
02
Make sure you have all the necessary information and documentation related to the medical service you received.
03
Contact your insurance provider to review your coverage and understand how the No Surprises Act applies to your situation.
04
If you received a surprise medical bill, you may need to file a complaint with the appropriate regulatory agency or seek legal assistance.
05
Keep detailed records of all communication and follow-up regarding the billing issue to ensure a timely resolution.

Who needs no surprises act?

01
Any individual who has received medical services from an out-of-network provider and is at risk of receiving a surprise medical bill.
02
Healthcare providers who are subject to the No Surprises Act regulations and need to ensure compliance with its provisions.

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The No Surprises Act is a federal law aimed at protecting patients from unexpected medical bills resulting from out-of-network care, especially in emergency situations or when patients receive care from non-participating providers at in-network facilities.
Healthcare providers, facilities, and insurers are required to comply with the No Surprises Act by providing necessary disclosures and adhering to the billing protections outlined in the law.
To comply with the No Surprises Act, providers must furnish a good faith estimate of costs for services to patients upon request and must notify patients of their rights about surprise billing. Additionally, they must ensure proper coding and documentation in accordance with federal guidelines.
The purpose of the No Surprises Act is to eliminate unexpected balance billing for patients when receiving emergency services or certain non-emergency services from out-of-network providers, thereby increasing transparency and protecting patient financial interests.
Providers must report the patient's estimated charges, the provider's network status, the patient's rights regarding surprise billing, and the process for disputing out-of-network bills as part of compliance with the No Surprises Act.
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