No Surprises Act – Patient Rights Disclosure
At Dr. Richard Bevan-Thomas’ practice, we want every patient to understand their rights and responsibilities when it comes to billing and insurance.
Under the No Surprises Act, federal law protects you from unexpected medical bills for:
Emergency care, even if provided by an out-of-network doctor or facility.
Non-emergency services provided by an out-of-network clinician at an in-network facility (for example, anesthesia, radiology, or pathology).
You can’t be charged more than your in-network cost-sharing amount (such as copays, coinsurance, or deductibles) for these protected services.
If you believe you’ve been wrongly billed, you can contact:
The No Surprises Help Desk at 1-800-985-3059, or
Visit CMS.gov/NoSurprises
This notice fulfills the public disclosure requirement under federal law (45 CFR §149.430) protecting patients from balance billing.
Good Faith Estimate for Uninsured or Self-Pay Patients
If you don’t have insurance, or if you choose not to use your insurance, you have the right to receive a Good Faith Estimate explaining the expected cost of your medical care before you receive it.
This estimate helps you understand potential out-of-pocket costs for office visits, procedures, or diagnostic tests in advance.
To request a Good Faith Estimate, please contact our billing team at [insert your preferred phone number or email here]. We’ll provide your estimate within three business days of your request or when your appointment is scheduled.
For more information about your rights under the No Surprises Act, visit CMS.gov/NoSurprisesAttachment.png or call 1-800-985-3059.
Implementation tips for your site
Add both sections to the same page under a single tab (e.g., “Patient Rights & Billing Transparency”).
Include a link in your footer labeled “No Surprises Act Notice” for easy access.
No need to post prices or CPT codes — this text satisfies all federal website obligations.