No Surprises
Act

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

What Is Balance Billing?

Balance billing happens when an out-of-network provider bills you for the difference between what your plan agreed to pay and the full amount charged for a service. The No Surprises Act protects you from this in certain situations.

Emergency Services

If you receive emergency care from an out-of-network provider or facility, the most you can be billed is your plan's in-network cost-sharing amount, such as copayments and coinsurance.

Certain Services at an In-Network Facility

When you receive care from an in-network hospital or surgical center, certain providers there may be out-of-network, including emergency medicine, anesthesia, pathology, radiology, laboratory, and surgical support staff. These providers cannot balance bill you beyond your plan's standard cost-sharing amounts.

Your Protections

• You are not required to give up your balance billing protections.
• You are never required to obtain out-of-network care.
• Your health plan generally must pay out-of-network providers and facilities directly.
• Your health plan must count your payments toward your in-network deductible and out-of-pocket limit.

Filing a Complaint

If you believe you have been wrongly billed, you can contact:

• Florida Insurance Consumer Helpline: 1-877-693-5236
• Florida Department of Health: 850-245-4444
• Agency for Health Care Administration: 888-419-3456

Visit cms.gov/nosurprises for more information about your rights under federal law.