No Surprises Act of 2022

As of January 2022, patients have the right to an estimate of the cost of services they will receive, called a Good Faith Estimate, and more protection from unexpected, or surprise bills when they receive care from out-of-network providers at in-network facilities. These protections are part of the Consolidated Appropriations Act of 2021, which includes the No Surprises Act. 

Good Faith Estimate.

You have the right to receive a "Good Faith Estimate" explaining how much your medical care will cost. Under the law, health care providers need to give patients who don't have insurance or who are not using insurance an estimate of the bill for medical items and services.

• You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescriptions drugs, equipment, and hospital fees.
• Make sure your health care provider, any any other provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, or any provider your choose, for a Good Faith Estimate before you schedule an item or service. 
• 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. 

Your Rights and Protections Against Surprise Medical Bills

When you get emergency care or are treated by an out-of-network provider or an in-network hospital or ambulatory surgical center, you are protected from balance billing. In these cases, you shouldn't be charged more than your plan's copayment, coinsurance, and/or deductible. 

What is "balance billing"? 

When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, like a copayment, coinsurance, or deductible. You may have additional costs or have to pay the entire bill if you see a provider or visit a health care facility that isn't in your health plan's network. Out-of-network means provider and facilities haven't signed a contract with your health plan to provide services. 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. This is called balance billing. This amount is 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. This 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. Surprise medical bills could cost thousands of dollars depending on the procedure or service. 

You are protected from balance billing for:

Emergency Services

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 (such as copayment, coinsurance, deductible). You cannot be balance billed for these emergency services. This includes services you may get after you're in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services. Additionally, Florida law protects patients with coverage through a Health Maintenance Organization (HMO) from balance billing for covered services, including emergency services, when the services are provided by an out-of-network provider. 

When balance billing isn't allowed, you also have these protections:

• You're only responsible for paying your share of the cost (copayments, coinsurance, deductible that you would pay if the provider or facility was in-network). Your health plan will pay any additional costs to out-of-network providers and facilities directly. 
• Generally, your health plan must:
  • Cover emergency services without requiring you to get approval for services in advance
  • Cover emergency services by out-of-network
  • Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of
  • Count any amount you pay for emergency services or out-of-network services toward your in-network deductible and out-of-pocket limit.

You are able to find a list of our fees on our website by clicking on our Fee Schedule. 

If you think you’ve been wrongly billed, contact The U.S. Centers for Medicare & Medicaid Services (CMS) at 1-800-MEDICARE (1-800-633-4227) or visit https://www.cms.gov/nosurprises/consumers for more information about your rights under federal law.

The Florida Department of Financial Services, Division of Consumer Services at 1-877-MY-FL-CFO

The federal phone number for information and complaints is: 1-800-985-3059.