Surprise Medical Bills and the No Surprises Act — Florida Consumer Guide 2026

What Is a Surprise Medical Bill?

A surprise medical bill happens when you receive care you believed was covered by your insurance — at an in-network hospital, for example — but later discover that one or more of the providers who treated you was out-of-network. Before 2022, this was a routine nightmare: you go to an in-network emergency room, and weeks later you receive a bill from an out-of-network anesthesiologist, radiologist, or assistant surgeon you never personally selected. The out-of-network provider then tried to collect the difference between what your insurer paid and their full billed charges — a practice called "balance billing."

The No Surprises Act (NSA), enacted as part of the Consolidated Appropriations Act of 2021 and effective January 1, 2022, put a hard stop to most of these situations. For Florida consumers, it works alongside the Florida Balance Billing Protection Act to provide overlapping layers of protection.

What the No Surprises Act Covers

The NSA applies to most private health insurance plans — employer-sponsored plans, ACA Marketplace plans, and individual/family plans. Medicare and Medicaid have separate but similar protections. The law's key prohibitions:

Out-of-Network Providers at In-Network Facilities

One of the most common surprise billing scenarios involves a scheduled procedure at an in-network hospital where a specialist — typically an anesthesiologist, assistant surgeon, or hospitalist — is out-of-network. Before the NSA, patients had no control over who was called to their operating room. Now, if you are at an in-network facility for a scheduled or emergency procedure, all providers involved in that care are subject to in-network cost-sharing caps, regardless of their individual network status.

There is one important exception: if you voluntarily choose to see an out-of-network provider for non-emergency care at an out-of-network facility, the NSA does not apply. This is a deliberate choice, not an involuntary assignment — and the rules treat it differently.

The Good Faith Estimate

The NSA created a new right for uninsured and self-pay patients: the Good Faith Estimate (GFE). Any healthcare provider or facility must give you a written GFE before scheduled care if you do not have insurance or choose not to use it. The GFE must include:

• The expected charges for the primary service
• Expected charges for any other providers involved (anesthesia, lab, imaging)
• The diagnosis and procedure codes
• The provider's name, address, and NPI number

If your final bill is more than $400 above the GFE, you can initiate a patient-provider dispute resolution through a federally approved independent dispute resolution entity. This puts the burden of justification on the provider, not on you.

The Independent Dispute Resolution Process

When a provider and an insurer cannot agree on the payment amount for an NSA-protected service, either party can initiate the federal Independent Dispute Resolution (IDR) process. An IDR entity — a neutral third party certified by the federal government — reviews the dispute and selects either the insurer's offer or the provider's offer (baseball-style arbitration). The losing party pays the IDR fee.

As a patient, you are not directly involved in IDR. Your only obligation is your in-network cost-sharing. The IDR process resolves the billing dispute between the insurer and the provider without any impact on what you owe.

Florida's Balance Billing Protection Act

Florida enacted its own Balance Billing Protection Act, which overlaps with federal law in some areas and goes further in others. Florida's law applies specifically to fully insured health plans regulated by the Florida Office of Insurance Regulation (FLOIR). Self-funded employer plans (governed by ERISA) fall under federal law only.

For Florida-regulated plans, the state law adds protections for some ground ambulance scenarios and requires specific dispute resolution timelines. When both state and federal law apply, the more protective rule governs. If you are on an employer self-insured plan, only federal NSA protections apply — contact your HR department if unsure which category you fall into.

How to File a Complaint if You Receive a Surprise Bill

If a provider bills you more than your in-network cost-sharing for NSA-protected care, do not pay the excess immediately. Take these steps:

1. Contact your insurer — send them the bill and your Explanation of Benefits. Ask them to intervene directly with the provider.
2. Contact the provider in writing — state that the service falls under the No Surprises Act and request that the excess charge be removed.
3. File a federal complaint — use the No Surprises Help Desk at 1-800-985-3059 or at cms.gov/nosurprises. CMS can investigate and penalize non-compliant providers.
4. File with Florida OIR — if you have a state-regulated plan, file at floir.com/Sections/ConsumerServices. The Florida Office of Insurance Regulation can take action against the insurer or provider.

Practical Steps When You Receive an Unexpected Bill

Step one is always to request your Explanation of Benefits (EOB) from your insurer for the date of service. Compare the EOB to the bill. If the bill is from an out-of-network provider who treated you at an in-network facility or during an emergency, the NSA almost certainly applies. Get an itemized bill, verify the provider was out-of-network, and contact your insurer's member services line.

For Florida residents comparing coverage options, FloridaPlanFinder.com lets you compare ACA plans and understand in-network provider networks before you enroll. Selecting a plan with broad networks in your area reduces your exposure to out-of-network situations in the first place. You can also get a free quote at GetFloridaCoverage.com or explore Gulf Coast plan options at GulfCoastCoverage.com.