New York Surprise Bill Form - Web this form is required for surprise bills in (1) below for dates of service before 1/1/22 and for surprise bills in (2) below for all dates of service. Sign a surprise bill certification form. You must sign a surprise bill certification form if: Many health plans cover their members for both. This form is not required for. Use this form if you receive a surprise bill for health care services and want the.
Web this form is required for surprise bills in (1) below for dates of service before 1/1/22 and for surprise bills in (2) below for all dates of service. Many health plans cover their members for both. This form is not required for. Use this form if you receive a surprise bill for health care services and want the. You must sign a surprise bill certification form if: Sign a surprise bill certification form.