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How to Dispute a Surprise Medical Bill in Florida

Use the free tool — Surprise Bill Shield

What is a surprise medical bill?

You went to a hospital that was in your insurance network. But a doctor who treated you there — an ER doctor, anesthesiologist, radiologist, assistant surgeon, or lab — was not in your network. Or you had an emergency and never got to choose where the ambulance took you. Now a bill has arrived for the difference, and it says "past due." This page explains, in plain language, whether that bill is allowed and what to do about it. This is not legal advice.

When the law says you're protected

Since January 1, 2022, the federal No Surprises Act bans balance billing for:

• Emergency services, including air ambulance
• Out-of-network providers who treat you at an in-network facility — unless you signed a written notice-and-consent at least 72 hours ahead of time

That consent form is not allowed at all for emergency care, anesthesiology, radiology, pathology, neonatology, assistant surgeons, hospitalists, intensivists, or diagnostic services. If your care falls into one of those categories, a consent form does not change your protection. This applies to employer plans, marketplace plans, and individual plans. It does not apply to ground ambulances. (Source: CMS — No Surprises Act, your rights.)

Florida law adds its own protection. Fla. Stat. 627.64194 (for PPO/EPO plans) and a parallel statute for HMO plans (641.513) prohibit balance billing for emergency services and for covered non-emergency services at an in-network facility when you had no ability to choose your provider. (Source: Fla. Stat. 627.64194.)

What you should actually owe

If the No Surprises Act or Florida law applies, the provider is required to charge you only your in-network cost sharing — the copay, coinsurance, or deductible amount you'd owe if that provider had been in-network. That amount should count toward your in-network deductible, and you can find it on your EOB (Explanation of Benefits) from your insurer.

If you have Medicare, the rules are different: a provider who accepts Medicare assignment cannot balance bill you at all; one who doesn't accept assignment is limited to 15% over the Medicare-approved amount. (Source: Medicare.gov — Lower costs with assignment.) Medicaid providers may not balance bill enrollees.

If you're uninsured, you should have received a Good Faith Estimate before your care. If your bill is $400 or more above that estimate, you can dispute it. (Source: CMS — Good Faith Estimates.)

What to do right now, before the due date

Do not ignore the bill and do not let it go to collections. Respond in writing before the due date, and keep every EOB you receive.

• Letter to the provider: state the facts of your care, cite the statute that applies, say you will pay only the in-network cost sharing shown on your EOB, and ask them to re-bill your insurer and stop collection.
• Letter to the insurer: ask them to reprocess the claim at in-network cost sharing under the No Surprises Act, and to confirm in writing.
• If it isn't fixed: file a complaint with the federal No Surprises Help Desk at 1-800-985-3059 or through the CMS complaint form. For state-regulated Florida plans, the Florida Department of Financial Services also takes complaints at 1-877-693-5236.

What these laws don't cover

• Ground ambulances — the No Surprises Act does not apply to them.
• A doctor's office visit you chose yourself, where you knew the provider was out-of-network.
• Care if you're uninsured — instead, ask about your Good Faith Estimate and the $400 dispute threshold.
• Medicare and Medicaid — these have their own separate balance-billing protections, described above.

What to do next

Paste the bill — who sent it, what it's for, where the care happened, what your insurance paid — along with your plan type, into the free tool. It reads your own document and numbers and tells you whether the bill appears prohibited, what you should owe instead, and gives you the letters to send. Nothing is stored, and there's no account. This tool is not a lawyer and can be wrong — confirm with the CMS No Surprises Help Desk (1-800-985-3059), the Florida Department of Financial Services, or an attorney before you rely on it.

Surprise Bill Shield explains the No Surprises Act and Florida balance-billing law in plain language; it can be wrong, and it is not legal advice. Confirm with the CMS No Surprises Help Desk, the Florida Department of Financial Services, or an attorney. Nothing you paste is stored.