Balance Billing Florida Laws and Protections

In Florida, balance billing is regulated by the state's insurance laws to protect consumers from surprise medical bills.

Florida law requires that health care providers accept the terms of a patient's insurance plan, including any network restrictions.

This means that providers cannot bill patients for services that are not covered by their plan or that exceed the plan's allowed amount.

The state's No Surprises Act also prohibits providers from charging patients more than the in-network cost-sharing amount for out-of-network services.

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The No Surprises Act was signed into law as part of the Consolidated Appropriations Act of 2021 on December 27, 2020.

This law is designed to protect patients from surprise medical bills, which can be a huge financial burden. Surprise medical bills can cost thousands of dollars depending on the procedure or service.

You're protected from balance billing in emergency situations or when you're treated by an out-of-network provider at an in-network hospital or ambulatory surgical center. In these cases, you should not be charged more than your plan's copayments, coinsurance, and/or deductible.

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Out-of-network providers may be allowed to bill you for the difference between what your plan pays and the full amount charged for a service, known as balance billing. This amount is likely more than in-network costs for the same service and might not count toward your plan's deductible or annual out-of-pocket limit.

Surprise billing is an unexpected balance bill that can happen when you can't control who is involved in your care, like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.

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You're protected from surprise billing in certain situations. If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most they can bill you is your plan's in-network cost-sharing amount.

You can't be balance billed for emergency services, unless you give written consent and give up your protections. This includes services you may get after you're in stable condition, unless you agree to be balance billed.

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In Florida, the law provides additional protection against balance billing for emergency services. If your insurance provider is from Florida, you can't be balance billed for emergency services, and you're only responsible for paying your copay, deductible, and coinsurance.

Certain services at an in-network hospital or ambulatory surgical center are also protected from balance billing. Emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services can't balance bill you, and may not ask you to give up your protections.

If you get other types of services at these in-network facilities, out-of-network providers can't balance bill you, unless you give written consent and give up your protections. You're never required to give up your protections from balance billing.

Here are some key services that are protected from balance billing:

Florida law also provides protections against balance billing for non-emergency visits if you're part of a Healthcare Management Organization (HMO) from Florida. If you're in a Preferred Provider Organization (PPO) from Florida, you're also protected.

In Florida, you're protected from surprise medical bills in emergency situations. If you receive emergency services from an out-of-network provider or facility, the most they can bill you is your plan's in-network cost-sharing amount.

You can't be balance billed for emergency services, unless you give written consent and give up your protections not to be balance billed for these post-stabilization services. This means you'll only be responsible for paying your copayments and coinsurance.

If you're treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you're also protected from balance billing. You should only be charged your plan's copayments, coinsurance, and/or deductible.

Some states, including Florida, have laws that prohibit certain surprise medical bills. You can visit the state's website to learn more about your protections under state law.

Here are the states with laws that prohibit certain surprise medical bills:

If you receive non-emergency services at an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network.

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These providers can't balance bill you for emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services, and can only charge your plan's in-network cost-sharing amount.

You're protected from balance billing for these services, and providers can't ask you to give up your protections.

You're never required to give up your protections from balance billing, and you can choose a provider or facility in your plan's network.

If you receive other services at these in-network facilities, out-of-network providers can't balance bill you, unless you give written consent and give up your protections.

Here are the states that have laws prohibiting certain surprise medical bills when you see an out-of-network provider:

If you believe you've been wrongly billed, contact your insurance company at the number on your ID card.

Balance billing can be a stressful and unexpected expense in Florida. Balance billing occurs when you see a provider or visit a facility that isn't in your health plan's network, and you may be billed for the difference between what your plan agreed to pay and the full amount charged for a service.

This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit. You may have additional costs or have to pay the entire bill in these situations.

In Florida, you have rights and protections against surprise medical bills. If you receive emergency care or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from balance billing.

You should not be charged more than your plan's copayments, coinsurance, and/or deductible in these cases. Surprise billing is an unexpected balance bill that can happen when you can't control who is involved in your care, such as in emergencies or when you're treated by an out-of-network provider at an in-network facility.

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In Florida, balance billing can be a surprise medical bill that can cost thousands of dollars. You may be billed for the difference between what your plan pays and the full amount charged for a service if you see an out-of-network provider.

Out-of-network providers are those who haven't signed a contract with your health plan to provide services. They may be allowed to bill you for the difference between what your plan pays and the full amount charged for a service.

This amount is likely more than in-network costs for the same service and might not count toward your plan's deductible or annual out-of-pocket limit. You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services upon request or when scheduling such items or services.

If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. Make sure to save a copy or picture of your Good Faith Estimate and the bill.

Here are some key rights you have under federal law: