Florida Surprise Billing Law

Overview

Florida relies on the federal No Surprises Act, effective January 1, 2022, for surprise billing protections. Emergency services are protected at in-network rates. OON providers at in-network facilities cannot charge more than in-network cost-sharing. Independent dispute resolution resolves rate disagreements.

Key Requirements

1. Emergency services are protected under federal NSA regardless of network status.
2. OON providers at in-network facilities cannot charge more than in-network cost-sharing.
3. Patients can request independent dispute resolution for rate disagreements.
4. Plans must resolve disputes within specified federal timelines.
5. AHCA can investigate complaints related to NSA compliance.

Penalties and Enforcement

Federal enforcement of NSA surprise billing violations includes CMS oversight and potential fines. State AHCA can investigate plan violations and enforce state law aspects. Providers and plans that systematically violate NSA face federal and state regulatory action.

Appeals and Exceptions

Disputed surprise billing charges can be appealed through plan dispute resolution and escalated to federal independent dispute resolution under NSA. AHCA can investigate state law violations. No exceptions exist for emergency or facility-based OON scenarios.

Interaction with Federal Law

Florida's surprise billing protections are primarily federal. The No Surprises Act provides broad emergency and facility-based OON protections. Federal enforcement applies alongside state oversight through AHCA.

Common Questions