Florida Balance Billing Law

Overview

Florida HB 221 (2016) provides balance billing protections focused on emergency services. Patients cannot be charged more than in-network cost-sharing for emergency care. Non-emergency OON protections are limited at state level, but the federal No Surprises Act applies to facility-based OON scenarios as of January 2022.

Key Requirements

1. Emergency services are protected from balance billing under Florida HB 221.
2. Federal No Surprises Act provides additional protections for OON at in-network facilities.
3. Non-emergency OON balance billing has limited state-level protections.
4. Plans must maintain dispute resolution processes for emergency balance billing claims.
5. Patients can file complaints with AHCA for emergency service violations.

Penalties and Enforcement

AHCA enforces emergency balance billing violations with regulatory action and consumer restitution. Plans that violate emergency protections face fines and corrective action orders. Enforcement is narrower than other states due to limited statute scope.

Appeals and Exceptions

Emergency service balance billing disputes can be appealed directly to the plan and escalated to AHCA. For federal NSA scenarios, federal independent dispute resolution applies. No exceptions exist for emergency services under HB 221.

Interaction with Federal Law

Florida HB 221 applies to emergency services. The federal No Surprises Act provides additional protections for emergency and facility-based OON scenarios effective January 1, 2022. Patients benefit from whichever protection is stronger.

Common Questions