Miami, FL

No Surprise Act

Your Rights and Protections
Against Surprise Medical Bills

When you get emergency care or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from balance billing. In these cases, you shouldn’t be charged more than your plan’s copayments, coinsurance and/or deductible.

What is “balance billing”
(sometimes called “surprise billing”)?

Dr. Gallagher, a blonde woman with long curly hair, is seated at a desk in her office with a large window overlooking a cityscape. She is smiling and looking off to the side while holding documents and a pen.

When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, like a copayment, coinsurance, or deductible. You may have additional costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network. “Out-of-network” means providers and facilities that haven’t signed a contract with your health plan to provide services. Out-of-network providers may be allowed to bill you for the difference between what your plan pays and the full amount charged for a service. This is called “balance billing”. This amount is likely more than in-network costs for the same service and might not count toward your plan’s deductible or annual out-of-pocket limit.

“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an in- network facility but are unexpectedly treated by an out-of-network provider. Surprise medical bills could cost thousands of dollars depending on the procedure or service.

You’re Protected From Balance Billing For:

Emergency Services

If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most they can bill you is your plan’s in-network cost-sharing amount (such as copayments, coinsurance, and deductibles). You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.

Additionally, Florida law protects patients with coverage through a Health Maintenance Organization (“HMO”) from balance billing for covered emergency services, when the services are provided by an out-of-network provider. The out-of-network provider is prohibited from billing the insured patient any excess amount (other than copayments, coinsurance, and deductibles).

Certain Services at an In-Network Hospital or Ambulatory Surgical Center

When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers can bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed. If you get other types of services at these in-network facilities, out-of-network providers can’t balance bill you, unless you give written consent and give up your protections.

You’re never required to give up your protections from balance billing. You also aren’t required to get out-of-network care. You can choose a provider or facility in your plan’s network.

Additionally, Florida law protects patients with health care insurance coverage from balance billing for covered non-emergency services provided at an in-network facility by an out-of-network provider and the patient did not have the opportunity to choose an in-network provider. This protection only requires patients to pay their in-network cost sharing amounts. The out-of- network provider is prohibited from billing the insured patient any excess amount (other than copayments, coinsurance, and deductibles).

When Balance Billing Isn’t Allowed, You Also Have These Protections:

You’re only responsible for paying your share of the cost (like the copayments, coinsurance, and deductible that you would pay if the provider or facility was in-network). Your health plan will pay any additional costs to out-of-network providers and facilities directly.
Generally, your health plan must:
- Cover emergency services without requiring you to get approval for services in advance (also known as “prior authorization”).
- Cover emergency services by out-of-network providers.
- Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.
- Count any amount you pay for emergency services or out-of-network services toward your in-network deductible and out-of-pocket limit.

If You Think You’ve Been Wrongly Billed, Contact:

The S. Centers for Medicare & Medicaid Services (CMS) No Surprises Help Desk at 1- 800-985- 3059 or visit https://www.cms.gov/nosurprises for more information about your rights under federal law.
The Florida Department of Financial Services, Division of Consumer Services, Consumer Helpline at 1-877-693-5236 or visit www.myfloridacfo.com/division/consumers for more information about your rights under Florida laws.:

See what our Patients Say

Patient Reviews

I had an amazing experience with Dr.Gallagher and her team, the whole experience from the procedure (top surgery) to the post-op care has been fantastic. Dr.Gallagher was able to address any concerns I had with my chest before the procedure and made me feel comfortable the whole way through, and then the attentiveness post-op is all the better.

Alfio Oliveira (Jay)
Thank you so much Dr. Gallagher for your amazing work! I appreciated the great support from your team at the surgical centre and your office. Everyone was so wonderful! I am extremely happy with my results and had a very positive experience. I had followed Dr. Gallagher for several years on Instagram prior to my surgery, and learned so much from her detailed explanations about various aspects of the surgical procedures, what to expect on the day, recovery, etc. I had complete trust, felt safe, felt listened to. I also appreciate the follow-ups, and answers to all my questions. The support, warmth, care is top notch!

Gill B.
Dr. Gallagher and her whole team, from Neasa to Daryl Ann and everyone else in between, are absolutely fantastic, kind hearted, hard working people. Dr. Gallagher truly amazed me and I’m so grateful to have had her on my team.

I was able to get keyhole top surgery about three weeks ago and I’m loving my results already! I’m muscular and heavier set as well but always had a smaller chest, and I’m so glad Dr. Gallagher was the one who could do this for me.

Right now I am still experiencing swelling, but I am using compression dressings every day, throughout the day which helps tons! I know that when the swelling subsides months from now, and everything is “back to normal”, I am going to love even more what I see in the mirror because I can finally see me.

Morgan F.
So glad I found Dr. Gallagher. I would not have elected to pursue my surgery had I not found a qualified and competent medical provider that I felt I could trust and have confidence in their ability to offer a high-quality, low-risk result. As a result of my initial contacts and consultations with Gallagher Plastic Surgery practice, I was willing to pursue my desired surgery and even travel half-way across the country to their offices. I’m so glad I did. The results are outstanding, more than I even anticipated. This was the 3rd practice I had dealt with and so I was learning what to look for and knew Dr. Gallagher was a good fit. The medical expertise and professionalism are what I based my decision on to proceed. They were calmly confident for a reason. I realized at the surgery event and through to the 3 week post-op checkin the excellence in their personal care (bed side manner). The office and Dr. Gallagher communicated very well. Everything went smoothly and as planned. As nervous as I was about an unnecessary surgery, Dr. Gallagher and her team were able to build enough trust that I was able to receive a very beneficial result.

Tim F.
Dr. Gallagher and her team are the absolute best! She completed my brachioplasty on Tuesday and when I saw the initial results at my post op appointment two days later I literally had tears of joy streaming down my face. My weight loss journey has been a road of many ups and downs, and I was so nervous about whether this surgery could even work for me. Even with the swelling that is normal after brachioplasty, there is an enormous difference, and I am still in disbelief that even this early on, my arms look this great. My husband was even in disbelief, and we’re so excited to see what I’ll look like in two weeks time. Dr. Gallagher is so kind and patient, and walked me through all of the phases of healing/expectations, and was great to call and check in. If you are looking for a highly skilled surgeon that will give you optimal results along with a compassionate approach, it is well worth your time and money to consider a consultation with her. I am forever thankful for her and for her team! This is life changing for me. Thank you, Dr. Gallagher! I appreciate you so much!

Melissa E.

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