No Surprises Act Florida: What You Need to Know

The No Surprises Act in Florida is designed to protect patients from surprise medical bills. In Florida, this law applies to emergency services, including air ambulance transport.

If you receive a surprise medical bill, you have the right to dispute it. You can contact the Florida Attorney General's office for assistance.

The No Surprises Act in Florida requires that patients be given a clear estimate of the expected costs before receiving treatment. This estimate must include the amount the patient is expected to pay out-of-pocket.

Florida law also requires that patients be given a notice of their rights under the No Surprises Act. This notice must be provided at the time of scheduling or at least 72 hours before treatment.

The No Surprises Act is a federal legislation that protects patients from getting stuck with exorbitant out-of-network medical bills. It became law on January 1, 2022, and was created to prevent situations where patients receive care from out-of-network providers while seeking treatment at an in-network facility.

You might be wondering how this can happen, especially in emergency situations. The truth is, during emergencies, patients may not have control over the providers they encounter, and that's exactly what the No Surprises Act aims to prevent.

The Act shields patients from balance billing, which is when out-of-network providers bill patients for the difference between what their plan agreed to pay and the full amount charged for a service. This can happen when patients see providers or visit facilities that aren't in their health plan's network.

Here are some key protections under the No Surprises Act:

Under Florida's implementation of the No Surprises Act, patients who receive emergency care or non-emergency care at an in-network facility cannot be charged out-of-network rates.

Healthcare providers and insurance companies are now required to inform patients, in advance, if any out-of-network services will be involved in their treatment. This notice must include a good faith estimate of the charges associated with these services.

The No Surprises Act ensures that patients undergoing ongoing treatments cannot be charged out-of-network rates if the provider joins or leaves the patient’s insurance network mid-treatment.

Here are the key provisions of Florida's No Surprises Act:

Florida has implemented the federal No Surprises Act to protect its residents from unexpected medical bills.

Under Florida's implementation, patients who receive emergency care or non-emergency care at an in-network facility cannot be charged out-of-network rates.

Healthcare providers and insurance companies must negotiate the payment amount, ensuring that the patient is only responsible for in-network cost-sharing.

Here are the key provisions of Florida's No Surprises Act:

Florida's implementation of the No Surprises Act has brought significant advantages for consumers, including protection from financial burden and transparency in healthcare costs.

Florida Provisions have some important exceptions to be aware of. Ground ambulance services are exempt from the state's billing protections, which means they can charge you out-of-network rates.

If you have vision-only or dental-only insurance, you're not protected from balance billing. This is because these types of insurances are not subject to the state's balance billing protections.

Indemnity plans, such as hospital indemnity insurance, are also exempt from the state's billing protections. This means you may be responsible for paying out-of-pocket for certain services or procedures.

You're protected from balance billing for emergency services, even if you receive care from an out-of-network provider or facility. The most the provider or facility may bill you is your plan's in-network cost-sharing amount.

Certain services at an in-network hospital or ambulatory surgical center are also protected. Emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services can't balance bill you.

Florida law adds additional protections, including a claim dispute resolution program for HMOs. However, these protections don't apply to ground ambulance services for PPO insurance plans, patients enrolled in PPO insurance plans who consent to non-emergency out-of-network services, and patients with self-funded insurance plans.

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

In Florida, the state payment standard applies to emergency services and non-emergency services provided by out-of-network providers at in-network facilities. This means that you'll only be responsible for your plan's in-network cost-sharing amount.

Surprise medical bills can be a huge financial burden, but fortunately, the No Surprises Act provides some protection.

You're protected from surprise billing or balance billing if you receive emergency care or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center.

Balance billing, also known as surprise billing, happens when you're unexpectedly charged by an out-of-network provider for services you thought were covered by your health plan.

Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service, known as balance billing.

Surprise billing can happen 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.

If you believe you've been wrongly billed, you can contact the Department of Health and Humans Services Center for Medicare and Medicaid Services by calling the No Surprises Helpdesk at 1-800-985-3059, or visiting http://www.cms.gov/nosurprises.

Here are your protections when balance billing isn't allowed:

+ Cover emergency services without prior authorization.

+ Cover emergency services by out-of-network providers.

+ Base what you owe the provider or facility on what it would pay an in-network provider or facility.

+ Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.