Alabama follows federal No Surprises Act provisions but has limited state-level surprise billing protections. The statute of limitations for medical debt is 6 years. Providers must comply with timely filing requirements set by individual payers.
Key Regulations
Federal No Surprises Act applies
No state surprise billing law
Balance billing permitted for out-of-network services
Alaska
Statute of Limitations: 3 years
Timely Filing Limit: 365 days
Balance Billing: Allowed
Surprise Billing Protection: No
Alaska has a 3-year statute of limitations on medical debt collection. The state relies primarily on federal protections under the No Surprises Act for surprise billing scenarios. Alaska's remote geography creates unique challenges for network adequacy.
Key Regulations
3-year statute of limitations for debt
Federal No Surprises Act applies
Remote area access considerations
Arizona
Statute of Limitations: 6 years
Timely Filing Limit: 365 days
Balance Billing: Not Allowed
Surprise Billing Protection: Yes
Arizona enacted surprise billing protections in 2022 limiting patient liability for out-of-network emergency services and certain non-emergency services at in-network facilities. The state prohibits balance billing for emergency services.
Key Regulations
ARS 20-3102 surprise billing protections
Balance billing prohibited for emergency services
IDR process for payment disputes
Arkansas
Statute of Limitations: 5 years
Timely Filing Limit: 365 days
Balance Billing: Allowed
Surprise Billing Protection: No
Arkansas has a 5-year statute of limitations for medical debt. The state does not have comprehensive surprise billing legislation beyond federal requirements. Individual payer contracts govern most billing practices.
Key Regulations
5-year statute of limitations
Federal No Surprises Act applies
Payer contract terms govern filing limits
California
Statute of Limitations: 4 years
Timely Filing Limit: 365 days
Balance Billing: Not Allowed
Surprise Billing Protection: Yes
California has robust surprise billing protections under AB 72 (2017) and AB 1611. Patients cannot be balance billed for emergency services or by out-of-network providers at in-network facilities. An independent dispute resolution process settles payment disagreements between providers and payers.
Key Regulations
AB 72 surprise billing protections
Knox-Keene Act managed care regulations
DMHC oversight of HMO billing practices
Limits on balance billing for emergency services
Colorado
Statute of Limitations: 6 years
Timely Filing Limit: 365 days
Balance Billing: Not Allowed
Surprise Billing Protection: Yes
Colorado enacted comprehensive surprise billing protections in 2020 (HB 19-1174). The law limits patient cost-sharing for out-of-network emergency services and establishes a binding arbitration process for payment disputes. Balance billing is prohibited for covered emergency services.
Key Regulations
HB 19-1174 surprise billing protections
Binding arbitration for out-of-network disputes
Balance billing prohibited for emergency services
Connecticut
Statute of Limitations: 6 years
Timely Filing Limit: 365 days
Balance Billing: Not Allowed
Surprise Billing Protection: Yes
Connecticut has strong consumer protections including surprise billing legislation that limits patient liability for out-of-network services at in-network facilities and emergency departments. The state maintains an arbitration process for provider-payer disputes.
Key Regulations
PA 15-146 surprise billing protections
Balance billing restrictions for emergencies
Arbitration process for payment disputes
Delaware
Statute of Limitations: 3 years
Timely Filing Limit: 365 days
Balance Billing: Allowed
Surprise Billing Protection: No
Delaware has a short 3-year statute of limitations for medical debt. The state relies primarily on federal No Surprises Act protections. Providers should be aware of the shorter collection window for patient balances.
Key Regulations
3-year statute of limitations
Federal No Surprises Act applies
Limited state-level billing regulations
Florida
Statute of Limitations: 5 years
Timely Filing Limit: 365 days
Balance Billing: Not Allowed
Surprise Billing Protection: Yes
Florida enacted surprise billing protections under HB 221 (2016) for emergency services and HMO enrollees. The law prohibits balance billing for emergency services by out-of-network providers and establishes a dispute resolution process.
Key Regulations
HB 221 surprise billing protections
Balance billing prohibited for HMO emergency services
Dispute resolution for out-of-network claims
Florida Patient's Bill of Rights
Georgia
Statute of Limitations: 6 years
Timely Filing Limit: 365 days
Balance Billing: Not Allowed
Surprise Billing Protection: Yes
Georgia enacted surprise billing legislation (SB 359) in 2020, prohibiting balance billing for emergency services and establishing an arbitration process. The law protects patients from unexpected out-of-network charges at in-network facilities.
Key Regulations
SB 359 surprise billing protections (2020)
Balance billing prohibited for emergencies
Arbitration for provider-payer disputes
Hawaii
Statute of Limitations: 6 years
Timely Filing Limit: 365 days
Balance Billing: Allowed
Surprise Billing Protection: No
Hawaii has unique insurance regulations under the Prepaid Health Care Act, which requires employers to provide health insurance. The state relies primarily on federal surprise billing protections. Hawaii's isolated geography impacts network adequacy and provider availability.
Key Regulations
Prepaid Health Care Act employer mandate
Federal No Surprises Act applies
Unique island state access considerations
Idaho
Statute of Limitations: 5 years
Timely Filing Limit: 365 days
Balance Billing: Allowed
Surprise Billing Protection: No
Idaho has a 5-year statute of limitations for medical debt and relies primarily on federal protections for surprise billing. The state has limited specific medical billing regulations beyond general insurance laws.
Key Regulations
5-year statute of limitations
Federal No Surprises Act applies
General insurance code provisions
Illinois
Statute of Limitations: 5 years
Timely Filing Limit: 365 days
Balance Billing: Not Allowed
Surprise Billing Protection: Yes
Illinois has comprehensive surprise billing protections under the Illinois Insurance Code. The law prohibits balance billing for emergency services and establishes patient protections for out-of-network services at in-network facilities. An arbitration process resolves payment disputes.
Key Regulations
215 ILCS 5/356z.3a surprise billing protections
Balance billing prohibited for emergency services
Arbitration process for disputes
Network adequacy requirements
Indiana
Statute of Limitations: 6 years
Timely Filing Limit: 365 days
Balance Billing: Not Allowed
Surprise Billing Protection: Yes
Indiana enacted surprise billing protections (HEA 1004) limiting patient liability for out-of-network emergency services. The law establishes a dispute resolution process between providers and insurers and restricts balance billing practices.
Key Regulations
HEA 1004 surprise billing protections
Balance billing restrictions
Dispute resolution process
Iowa
Statute of Limitations: 5 years
Timely Filing Limit: 365 days
Balance Billing: Allowed
Surprise Billing Protection: No
Iowa has a 5-year statute of limitations for medical debt collection. The state relies on federal No Surprises Act protections and does not have comprehensive state-level surprise billing legislation.
Key Regulations
5-year statute of limitations
Federal No Surprises Act applies
Iowa Insurance Code provisions
Kansas
Statute of Limitations: 5 years
Timely Filing Limit: 365 days
Balance Billing: Allowed
Surprise Billing Protection: No
Kansas has a 5-year statute of limitations for medical debt. The state does not have comprehensive surprise billing legislation and relies on federal protections. Individual payer contracts set most billing requirements.
Key Regulations
5-year statute of limitations
Federal No Surprises Act applies
General insurance regulations
Kentucky
Statute of Limitations: 5 years
Timely Filing Limit: 365 days
Balance Billing: Allowed
Surprise Billing Protection: No
Kentucky has a 5-year statute of limitations for medical debt. The state does not have comprehensive surprise billing protections beyond federal law. Kentucky regulates managed care organizations through the Department of Insurance.
Key Regulations
5-year statute of limitations
Federal No Surprises Act applies
KRS Chapter 304 insurance regulations
Louisiana
Statute of Limitations: 3 years
Timely Filing Limit: 365 days
Balance Billing: Allowed
Surprise Billing Protection: No
Louisiana has a relatively short 3-year statute of limitations for medical debt. The state follows federal surprise billing protections. Louisiana has specific Medicaid billing requirements and operates a managed care Medicaid program.
Key Regulations
3-year statute of limitations
Federal No Surprises Act applies
Medicaid managed care regulations
Maine
Statute of Limitations: 6 years
Timely Filing Limit: 365 days
Balance Billing: Not Allowed
Surprise Billing Protection: Yes
Maine has surprise billing protections that limit patient cost-sharing for out-of-network emergency services and prohibit balance billing in certain situations. The state maintains consumer protection standards for healthcare billing.
Key Regulations
Surprise billing protections
Balance billing restrictions
Consumer protection standards
Maryland
Statute of Limitations: 3 years
Timely Filing Limit: 365 days
Balance Billing: Not Allowed
Surprise Billing Protection: Yes
Maryland has a unique all-payer rate-setting system regulated by the Health Services Cost Review Commission (HSCRC). This system reduces surprise billing issues by standardizing hospital charges. The state also has specific balance billing protections.
Key Regulations
HSCRC all-payer rate setting
Balance billing protections
Standardized hospital charge regulations
HB 1122 surprise billing
Massachusetts
Statute of Limitations: 6 years
Timely Filing Limit: 365 days
Balance Billing: Not Allowed
Surprise Billing Protection: Yes
Massachusetts has comprehensive surprise billing protections and mandates that out-of-network providers at in-network facilities cannot balance bill patients. The state's health reform law provides additional consumer protections and requires most residents to have health insurance.
Key Regulations
Chapter 224 health care cost containment
Surprise billing protections
Balance billing prohibited at in-network facilities
Individual mandate for health insurance
Michigan
Statute of Limitations: 6 years
Timely Filing Limit: 365 days
Balance Billing: Allowed
Surprise Billing Protection: No
Michigan has a 6-year statute of limitations for medical debt and relies primarily on federal No Surprises Act protections. The state has specific regulations for auto insurance medical billing due to its no-fault auto insurance system.
Key Regulations
6-year statute of limitations
No-fault auto insurance medical billing
Federal No Surprises Act applies
Minnesota
Statute of Limitations: 6 years
Timely Filing Limit: 365 days
Balance Billing: Not Allowed
Surprise Billing Protection: Yes
Minnesota has surprise billing protections that restrict balance billing for emergency services and out-of-network services at in-network facilities. The state maintains strong consumer protection standards for healthcare billing practices.
Key Regulations
Surprise billing protections
Balance billing restrictions for emergencies
Consumer protection standards
Department of Commerce oversight
Mississippi
Statute of Limitations: 3 years
Timely Filing Limit: 365 days
Balance Billing: Allowed
Surprise Billing Protection: No
Mississippi has a 3-year statute of limitations for medical debt. The state does not have comprehensive surprise billing legislation and relies on federal protections. Mississippi has specific Medicaid billing requirements for its managed care program.
Key Regulations
3-year statute of limitations
Federal No Surprises Act applies
Medicaid billing requirements
Missouri
Statute of Limitations: 5 years
Timely Filing Limit: 365 days
Balance Billing: Not Allowed
Surprise Billing Protection: Yes
Missouri has enacted surprise billing protections (SB 579) that restrict balance billing for emergency services and certain out-of-network situations. The state maintains consumer protections through the Department of Commerce and Insurance.
Key Regulations
SB 579 surprise billing protections
Balance billing restrictions
Department of Commerce and Insurance oversight
Montana
Statute of Limitations: 5 years
Timely Filing Limit: 365 days
Balance Billing: Allowed
Surprise Billing Protection: No
Montana has a 5-year statute of limitations for medical debt and relies on federal surprise billing protections. The state has specific requirements for rural health clinics and critical access hospitals given its rural geography.
Key Regulations
5-year statute of limitations
Federal No Surprises Act applies
Rural health clinic regulations
Nebraska
Statute of Limitations: 5 years
Timely Filing Limit: 365 days
Balance Billing: Allowed
Surprise Billing Protection: No
Nebraska has a 5-year statute of limitations for medical debt collection. The state relies on federal No Surprises Act protections and does not have comprehensive state-level surprise billing legislation.
Key Regulations
5-year statute of limitations
Federal No Surprises Act applies
Nebraska Insurance Code provisions
Nevada
Statute of Limitations: 6 years
Timely Filing Limit: 365 days
Balance Billing: Not Allowed
Surprise Billing Protection: Yes
Nevada enacted comprehensive surprise billing protections (SB 426, 2019) that prohibit balance billing for emergency services and limit out-of-pocket costs for patients receiving out-of-network care at in-network facilities.
Key Regulations
SB 426 surprise billing protections (2019)
Balance billing prohibited for emergencies
Out-of-network cost protections
New Hampshire
Statute of Limitations: 3 years
Timely Filing Limit: 365 days
Balance Billing: Allowed
Surprise Billing Protection: No
New Hampshire has a 3-year statute of limitations for medical debt. The state follows federal surprise billing protections and has general insurance regulations through the Department of Insurance.
Key Regulations
3-year statute of limitations
Federal No Surprises Act applies
Department of Insurance regulations
New Jersey
Statute of Limitations: 6 years
Timely Filing Limit: 365 days
Balance Billing: Not Allowed
Surprise Billing Protection: Yes
New Jersey has strong surprise billing protections under the Out-of-Network Consumer Protection Act (2018). The law establishes an arbitration process for out-of-network billing disputes and prohibits balance billing for emergency and inadvertent out-of-network services.
Key Regulations
Out-of-Network Consumer Protection Act (2018)
Balance billing prohibited for emergencies
Arbitration for out-of-network disputes
Transparency requirements
New Mexico
Statute of Limitations: 6 years
Timely Filing Limit: 365 days
Balance Billing: Not Allowed
Surprise Billing Protection: Yes
New Mexico has surprise billing protections that limit patient liability for out-of-network emergency services. The state maintains consumer protection standards through the Office of Superintendent of Insurance.
Key Regulations
Surprise billing protections
Balance billing restrictions
OSI oversight
New York
Statute of Limitations: 6 years
Timely Filing Limit: 365 days
Balance Billing: Not Allowed
Surprise Billing Protection: Yes
New York was a pioneer in surprise billing protections with its Emergency Medical Services and Surprise Bills law (2015). The law established an independent dispute resolution process and prohibits balance billing for emergency services and surprise out-of-network services. New York's law served as a model for the federal No Surprises Act.
Key Regulations
Emergency Medical Services and Surprise Bills law (2015)
Independent Dispute Resolution (IDR) process
Balance billing prohibited
Assignment of benefits provisions
North Carolina
Statute of Limitations: 3 years
Timely Filing Limit: 365 days
Balance Billing: Allowed
Surprise Billing Protection: No
North Carolina has a 3-year statute of limitations for medical debt. The state relies on federal surprise billing protections. North Carolina has specific requirements for certificate-of-need programs affecting hospital billing.
Key Regulations
3-year statute of limitations
Federal No Surprises Act applies
Certificate of need requirements
North Dakota
Statute of Limitations: 6 years
Timely Filing Limit: 365 days
Balance Billing: Allowed
Surprise Billing Protection: No
North Dakota has a 6-year statute of limitations for medical debt and relies on federal protections for surprise billing. The state has specific billing requirements for its Medicaid expansion program.
Key Regulations
6-year statute of limitations
Federal No Surprises Act applies
Medicaid expansion billing rules
Ohio
Statute of Limitations: 6 years
Timely Filing Limit: 365 days
Balance Billing: Not Allowed
Surprise Billing Protection: Yes
Ohio has enacted surprise billing protections (HB 388) that restrict balance billing for emergency services and establish patient protections for out-of-network services received at in-network facilities.
Key Regulations
HB 388 surprise billing protections
Balance billing restrictions
Department of Insurance oversight
Oklahoma
Statute of Limitations: 5 years
Timely Filing Limit: 365 days
Balance Billing: Allowed
Surprise Billing Protection: No
Oklahoma has a 5-year statute of limitations for medical debt. The state does not have comprehensive surprise billing legislation beyond federal requirements. Oklahoma operates a competitive healthcare market with limited price regulation.
Key Regulations
5-year statute of limitations
Federal No Surprises Act applies
Oklahoma Insurance Code
Oregon
Statute of Limitations: 6 years
Timely Filing Limit: 365 days
Balance Billing: Not Allowed
Surprise Billing Protection: Yes
Oregon has surprise billing protections (HB 2089) that prohibit balance billing for emergency services and limit patient liability for out-of-network services at in-network facilities. The state also requires price transparency.
Key Regulations
HB 2089 surprise billing protections
Balance billing prohibited for emergencies
Price transparency requirements
Pennsylvania
Statute of Limitations: 4 years
Timely Filing Limit: 365 days
Balance Billing: Not Allowed
Surprise Billing Protection: Yes
Pennsylvania has surprise billing protections (Act 112, 2020) that prohibit balance billing for emergency services and establish a dispute resolution process. The state also maintains comprehensive consumer protection standards.
Key Regulations
Act 112 surprise billing protections (2020)
Balance billing prohibited for emergencies
Dispute resolution process
Consumer protection standards
Rhode Island
Statute of Limitations: 10 years
Timely Filing Limit: 365 days
Balance Billing: Allowed
Surprise Billing Protection: No
Rhode Island has a lengthy 10-year statute of limitations for medical debt. The state relies on federal surprise billing protections and maintains insurance regulations through the Department of Business Regulation.
Key Regulations
10-year statute of limitations
Federal No Surprises Act applies
Department of Business Regulation oversight
South Carolina
Statute of Limitations: 3 years
Timely Filing Limit: 365 days
Balance Billing: Allowed
Surprise Billing Protection: No
South Carolina has a 3-year statute of limitations for medical debt. The state does not have comprehensive surprise billing legislation and relies on federal protections under the No Surprises Act.
Key Regulations
3-year statute of limitations
Federal No Surprises Act applies
General insurance regulations
South Dakota
Statute of Limitations: 6 years
Timely Filing Limit: 365 days
Balance Billing: Allowed
Surprise Billing Protection: No
South Dakota has a 6-year statute of limitations for medical debt. The state relies on federal No Surprises Act protections and has general insurance regulations through the Division of Insurance.
Key Regulations
6-year statute of limitations
Federal No Surprises Act applies
Division of Insurance regulations
Tennessee
Statute of Limitations: 6 years
Timely Filing Limit: 365 days
Balance Billing: Allowed
Surprise Billing Protection: No
Tennessee has a 6-year statute of limitations for medical debt. The state relies on federal protections for surprise billing. Tennessee operates the TennCare Medicaid managed care program with specific billing requirements.
Key Regulations
6-year statute of limitations
Federal No Surprises Act applies
TennCare billing requirements
Texas
Statute of Limitations: 4 years
Timely Filing Limit: 365 days
Balance Billing: Not Allowed
Surprise Billing Protection: Yes
Texas enacted comprehensive surprise billing protections under SB 1264 (2019), one of the strongest state laws in the country. The law prohibits balance billing for emergency services and out-of-network services at in-network facilities, and establishes a mediation/arbitration process for payment disputes.
Key Regulations
SB 1264 surprise billing protections (2019)
Balance billing prohibited for emergencies
Mandatory mediation for disputes over $500
Texas Department of Insurance oversight
Utah
Statute of Limitations: 6 years
Timely Filing Limit: 365 days
Balance Billing: Allowed
Surprise Billing Protection: No
Utah has a 6-year statute of limitations for medical debt collection. The state relies on federal surprise billing protections and maintains general insurance regulations through the Insurance Department.
Key Regulations
6-year statute of limitations
Federal No Surprises Act applies
Utah Insurance Code provisions
Vermont
Statute of Limitations: 6 years
Timely Filing Limit: 365 days
Balance Billing: Not Allowed
Surprise Billing Protection: Yes
Vermont has surprise billing protections and maintains comprehensive healthcare regulation through the Green Mountain Care Board. The state limits balance billing and maintains strong consumer protections for healthcare billing.
Key Regulations
Surprise billing protections
Green Mountain Care Board oversight
Balance billing restrictions
Healthcare price transparency
Virginia
Statute of Limitations: 5 years
Timely Filing Limit: 365 days
Balance Billing: Not Allowed
Surprise Billing Protection: Yes
Virginia enacted surprise billing protections (HB 1251/SB 172, 2020) that prohibit balance billing for emergency services and certain scheduled services at in-network facilities. The law establishes an arbitration process for payment disputes.
Washington has comprehensive surprise billing protections under the Balance Billing Protection Act (2019). The law prohibits balance billing for emergency services and establishes a dispute resolution process. Washington also has strong healthcare price transparency requirements.
Key Regulations
Balance Billing Protection Act (2019)
Balance billing prohibited for emergencies
Dispute resolution process
Healthcare price transparency requirements
West Virginia
Statute of Limitations: 10 years
Timely Filing Limit: 365 days
Balance Billing: Allowed
Surprise Billing Protection: No
West Virginia has a lengthy 10-year statute of limitations for medical debt. The state relies on federal surprise billing protections and maintains general insurance regulations. West Virginia has specific Medicaid billing requirements.
Key Regulations
10-year statute of limitations
Federal No Surprises Act applies
Medicaid billing requirements
Wisconsin
Statute of Limitations: 6 years
Timely Filing Limit: 365 days
Balance Billing: Not Allowed
Surprise Billing Protection: Yes
Wisconsin has surprise billing protections that limit patient liability for out-of-network emergency services. The state maintains balance billing restrictions and consumer protection standards through the Office of the Commissioner of Insurance.
Key Regulations
Surprise billing protections
Balance billing restrictions
OCI oversight
Consumer protection standards
Wyoming
Statute of Limitations: 8 years
Timely Filing Limit: 365 days
Balance Billing: Allowed
Surprise Billing Protection: No
Wyoming has an 8-year statute of limitations for medical debt. The state relies on federal surprise billing protections and has general insurance regulations. Wyoming's rural geography impacts provider network availability.