All tools · Surprise Bill Shield

Got a Bill From an Out-of-Network ER Doctor?

Use the free tool — Surprise Bill Shield

What happened to you

You went to a hospital that is in your insurance network. But the ER doctor, anesthesiologist, radiologist, assistant surgeon, or lab that treated you might not be. Now you have a bill from someone you never chose. This is called a surprise bill.

What the law says

Since January 1, 2022, the federal No Surprises Act bans surprise bills for emergency care and for out-of-network providers at an in-network facility. See CMS — No Surprises Act, your rights.

• This applies to employer plans, marketplace plans, and individual plans.
• It does not apply if you signed a written notice-and-consent form at least 72 hours in advance — and that consent is not allowed for emergency care, anesthesiology, radiology, pathology, neonatology, assistant surgeons, hospitalists, intensivists, or diagnostic services.
• It does not apply to ground ambulances. Air ambulances are covered by the ban.

Florida has its own law too. Fla. Stat. 627.64194 bans balance billing for emergency services and for in-network-facility care you couldn't choose.

What you should actually owe

If the law protects you, you should only pay your in-network cost sharing — the amount that counts toward your in-network deductible, shown on your insurer's Explanation of Benefits (EOB). You should not owe the difference between what the provider billed and what your insurance paid.

When these laws don't apply

• Ground ambulance — not covered by the federal ban.
• A doctor's office visit you chose yourself — not a surprise bill.
• Medicare — a provider who accepts assignment cannot balance bill you. One who doesn't accept assignment is limited to 15% over the Medicare-approved amount. See Medicare.gov — Lower costs with assignment.
• Medicaid — providers may not balance bill Medicaid enrollees.
• Uninsured / self-pay — you should have received a Good Faith Estimate. You can dispute a bill that's $400 or more above that estimate. See CMS — Good Faith Estimates.

What to send, and where to complain

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

• To the provider: state the facts of your care, cite the statute, 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.
• To the insurer: ask them to reprocess the claim at in-network cost sharing under the No Surprises Act, and to confirm in writing.
• To complain: the federal No Surprises Help Desk, 1-800-985-3059, or file at CMS — Submit a complaint. For Florida-regulated plans, the Florida Department of Financial Services, 1-877-693-5236.

What to do next

This page is general information, not legal advice, and it can be wrong. The free tool reads your own bill and your own insurance details — who billed you, how much, where the care happened, and what your insurance paid — and tells you whether federal or Florida law likely protects you, what you should actually owe, and gives you the letters to send. Nothing you paste is stored. Confirm anything important with the CMS No Surprises Help Desk or the Florida Department of Financial Services 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.