Surprise Billing Protection

Effective January 1, 2022, the No Surprises Act, passed by Congress as part of the Consolidated Appropriations Act of 2021, aims to shield patients from unexpected bills for emergency services at out-of-network facilities or from out-of-network providers at in-network facilities. Patients are now held responsible solely for in-network cost-sharing amounts. Additionally, the No Surprises Act provides uninsured patients with a good faith estimate of care costs.

Billing Disclosures – Your Rights and Protections Against Surprise Medical Bills

When you receive emergency care or treatment from an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise or balance billing.

What is “balance billing” (sometimes called “surprise billing”)?

When you visit a healthcare provider, you may owe certain out-of-pocket costs, such as copayments, coinsurance, and/or a deductible. If you see a provider or visit a facility not covered by your health plan, you may face additional costs or have to pay the entire bill.

“Out-of-network” refers to providers and facilities not contracted with your health plan. Out-of-network providers may bill you for the difference between what your plan agreed to pay and the full amount charged for a service, termed “balance billing.” This amount is usually higher than in-network costs for the same service and might not count toward your annual out-of-pocket limit.

“Surprise billing” occurs when you receive an unexpected balance bill. This can happen in situations beyond your control, such as emergencies or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.

You are protected from balance billing for:

• Emergency services
• Certain services at in-network hospitals or ambulatory surgical centers

Additionally, Florida law safeguards patients covered by a Health Maintenance Organization (“HMO”) from balance billing for covered services, including emergency services provided by out-of-network providers.

If you believe you’ve received an incorrect bill, you may contact:

• The U.S. Centers for Medicare & Medicaid Services (CMS) at 1-800-MEDICARE (1-800-633-4227) or visit cms.gov/nosurprises for federal law rights information.
• The Florida Department of Financial Services, Division of Consumer Services at 1-877-MY-FL-CFO.

Good Faith Estimate

You have the right to receive a “Good Faith Estimate” explaining your medical care costs.

Under the law, healthcare providers must provide uninsured or non-insurance-using patients with an estimate of medical items and services costs.

• You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services.
• Ensure your healthcare provider provides a written Good Faith Estimate at least one business day before your medical service or item. You can also request a Good Faith Estimate before scheduling.
• If you receive a bill at least $400 more than your Good Faith Estimate, you can dispute it.
• Keep a copy or picture of your Good Faith Estimate for your records.

For questions or more information about your right to a Good Faith Estimate, visit cms.gov/nosurprises or call 1-800-MEDICARE (1-800-633-4227).