Medical Billing Rights
Written in plain language for general understanding. This is educational content, not legal advice. Based on federal statutes and official sources.
What is this right?
The No Surprises Act, which took effect on January 1, 2022, protects you from unexpected medical bills when you receive emergency care or are treated by an out-of-network provider at an in-network facility. Before this law, patients could receive bills for thousands of dollars from doctors or hospitals they did not choose.
Under the No Surprises Act, out-of-network providers cannot bill you more than your in-network cost-sharing amount in most emergency and certain non-emergency situations. If you are uninsured or choose to self-pay, you have the right to a good faith estimate of costs before treatment. You also have the right to an itemized bill for any medical services, and you can dispute charges you believe are incorrect.
When does it apply?
This right applies when:
- You receive emergency care at any hospital or emergency room, regardless of network status
- An out-of-network doctor (such as an anesthesiologist, radiologist, or pathologist) treats you at an in-network hospital
- You are airlifted or transported by an out-of-network air ambulance
- You are uninsured or choose to self-pay and want to know costs up front
- You receive a bill you believe is incorrect or too high
Common misconceptions:
- “The No Surprises Act covers all medical bills” — It primarily covers emergency services and out-of-network providers at in-network facilities. If you knowingly choose an out-of-network provider and sign a consent notice, you may still receive higher bills.
- “I can't fight a medical bill” — You can always request an itemized bill, dispute charges, and ask for a payment plan or financial assistance.
- “If I'm uninsured, I have no billing protections” — The No Surprises Act requires providers to give uninsured patients a good faith estimate. If the final bill exceeds the estimate by $400 or more, you can dispute it through the patient-provider dispute resolution process.
What should you do?
Step 1: If you are uninsured or self-paying, ask for a good faith estimate before any scheduled service. Providers and facilities must give you an estimate of expected charges. Keep this document.
Step 2: Review every medical bill you receive. Request an itemized bill that lists each service, supply, and charge individually. Compare it with the explanation of benefits (EOB) from your insurer.
Step 3: If you receive a surprise bill for emergency care or from an out-of-network provider at an in-network facility, contact your insurer and the provider. Under the No Surprises Act, you should only owe your in-network cost-sharing amount (copay, coinsurance, or deductible).
Step 4: If the final bill exceeds your good faith estimate by $400 or more, start the patient-provider dispute resolution process at cms.gov/nosurprises or call 1-800-985-3059. You must initiate the dispute within 120 days of the bill.
Step 5: Ask about financial assistance. Nonprofit hospitals are required to have charity care programs under IRS rules (26 U.S.C. § 501(r)). Many for-profit hospitals also offer financial assistance or payment plans. Always ask for a financial counselor.
What should you NOT do?
Don't ignore medical bills. Unpaid medical bills can be sent to collections and damage your credit score. Even if you plan to dispute a bill, respond within the timeframes given.
Don't sign a waiver of your surprise billing protections unless you understand the consequences. Some out-of-network providers may ask you to sign a “notice and consent” form giving up your No Surprises Act protections. You are never required to sign this for emergency services, and for non-emergency services, you should understand that signing means you agree to pay out-of-network rates.
Don't pay a bill you believe is wrong without questioning it. Medical billing errors are common. Studies estimate that a significant percentage of medical bills contain mistakes. Always request an itemized bill and check it carefully.
Don't assume you cannot negotiate. Many providers will reduce bills, set up interest-free payment plans, or offer discounts for prompt payment. Ask before paying the full amount.
How Florida differs from federal law
Florida has state-level billing protections supplementing the federal No Surprises Act:
- Balance billing protections: Florida enacted HB 221 (2016) and subsequent legislation providing protections against surprise bills from out-of-network providers in emergency situations at in-network facilities.
- Florida Patient's Bill of Rights (Fla. Stat. § 381.026): Patients have the right to receive an itemized bill that is reasonably clear and understandable, and to receive an explanation of charges.
- Homestead exemption: Florida's unlimited homestead exemption (Art. X, § 4) means medical creditors cannot force the sale of your primary residence to collect medical debt, regardless of the amount owed.
- Head of household wage protection: If you are head of household, your wages are 100% exempt from garnishment for medical debt. Otherwise, 25% of disposable earnings can be garnished (federal limit).
Additional Steps in Florida
Request an itemized bill and ask about financial assistance. File complaints with the Florida Office of Insurance Regulation at floir.com or call (877) 693-5236. For federal No Surprises Act disputes, visit cms.gov/nosurprises. Contact Florida Legal Services at (800) 405-1417.
Relevant Law: Fla. Stat. § 381.026 (Patient's Bill of Rights), Fla. Stat. § 395.003 (balance billing protections), Florida Constitution Art. X, § 4 (homestead exemption), Fla. Stat. § 222.11 (wage exemption)
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