Can you get treated after a crash if you have no health insurance?
Yes, for the emergency. A Florida hospital emergency department cannot turn you away, or hold up your exam to ask how you will pay, because you have no health insurance. After that, your own car insurance’s personal injury protection pays first, 80 percent of reasonable bills up to $10,000, if you are seen within 14 days. The hard part comes later, in the weeks after the emergency room, when the follow-up care that decides a claim is care nobody has to give you for free.
You will still get a bill. Nothing in the law makes the emergency room free, and nothing makes a bill disappear because a claim is open. What the law does decide is the order things happen in, who is allowed to ask you for what, and how an unpaid medical bill is treated as evidence when a case is filed. Most people in this position are asking three things: will anyone treat me, who sends me to collections, and what does having no insurance do to my claim. Here they are in the order they come up.
Paul R. Shalhoub handles these claims himself, and spent the early years of his career defending insurance companies against them.
What an emergency room has to do when you have no insurance
The duty is real and it is narrow. It covers the emergency, not what comes after.
| It has to examine you | A hospital with an emergency department must provide “an appropriate medical screening examination” to find out whether an emergency medical condition exists, and if one does, treatment to stabilize it or a lawful transfer, under 42 U.S.C. 1395dd(a) and (b). Florida says the same in section 395.1041(3)(a): every general hospital with an emergency department must provide emergency services and care for any emergency medical condition when a person requests them |
| It cannot ask about payment first | The federal statute bars a hospital from delaying the exam or the treatment “in order to inquire about the individual’s method of payment or insurance status” (subsection (h)). Florida adds, in section 395.1041(3)(f), that emergency services may not be “based upon, or affected by” the person’s “insurance status, economic status, or ability to pay for medical services” |
| The ambulance cannot ask first either | Under section 395.1041(3)(k)1, emergency medical services providers “may not condition the prehospital transport of any person in need of emergency services and care on the person’s ability to pay.” The same paragraph then says the patient “shall execute an agreement to pay for the transport or otherwise supply insurance or credit information promptly after the transport is rendered.” Transport is not refused. The bill follows |
| What it does not do | It does not make the care free, and it does not reach the MRI the following week, the orthopedic visit, or physical therapy. Those are not emergencies, and that is where people without insurance stop getting care |
Does PIP pay if you have no health insurance?
Yes. Personal injury protection does not ask whether you have health insurance. It asks whether you were hurt in a crash involving a vehicle covered by a Florida policy.
Section 627.736(1) extends PIP to the named insured, relatives living in the same household, the person operating the insured vehicle, its passengers, and “other persons struck by the motor vehicle and suffering bodily injury while not an occupant of a self-propelled vehicle.” That is how a pedestrian, a cyclist or a passenger who owns no car and carries no health insurance can still have $10,000 available. It pays 80 percent of reasonable, medically necessary expenses, and only if the first treatment happens within 14 days of the crash.
Two details decide how much of that $10,000 you actually get. Under paragraph (1)(a), the full $10,000 is available when a physician, dentist, physician assistant or advanced practice registered nurse has determined you had an emergency medical condition, and reimbursement is limited to $2,500 when a listed provider determines you did not. That determination is usually made in the first visit, which is one reason the emergency room chart matters more than it looks. Which hospital you go to, and what the first chart says is its own question.
There is also a protection written for the person who is worried about the leftover bill. Where an insurer pays according to the statutory fee schedule, section 627.736(5)(a)4 says the provider “may not bill or attempt to collect from the insured any amount in excess of such limits,” except the 20 percent coinsurance and amounts beyond the policy limit. A provider who sends you the difference between its full price and what PIP paid is, in that situation, billing you for something the statute says it may not. The full order of who pays what is in who pays the medical bills after a crash.
PIP runs out. Ten thousand dollars covers an emergency visit and a few weeks of therapy, not a surgery. What happens when it is gone is the next problem.
Where can you get treated in the weeks after the emergency room?
These are the real options for a person without health insurance in Palm Beach County, with what each one does and does not do.
| The Health Care District’s community health centers | The Health Care District of Palm Beach County runs community health centers as a Federally Qualified Health Center, with a Sliding Fee Discount Program based on family size and household income, open to patients with or without insurance. Its page says: “You will never be turned away because you cannot pay.” It says a payment plan can be set up, and that the application is offered in English, Spanish and Creole. You must give income and family size information within 14 consecutive days of your first appointment. It lists primary care, women’s health, dental, mental health, pharmacy, mammography, optometry and routine labs. It does not list MRI, orthopedics or physical therapy, so call and ask what they can arrange for a crash injury. There are nine locations, including West Palm Beach, Mangonia Park, Atlantis, Delray Beach and Jupiter |
| A hospital’s financial assistance policy | A hospital run by a tax-exempt organization must, under 26 U.S.C. 501(r), have a written financial assistance policy, limit what it charges an eligible patient to “not more than the amounts generally billed to individuals who have insurance covering such care,” and not take extraordinary collection actions before making reasonable efforts to decide whether you are eligible. Not every hospital is tax-exempt. Ask the billing office whether the hospital has the policy and for a copy of it, in writing, before you pay anything |
| Paying yourself, with receipts | Under section 768.0427(2)(a), evidence of a bill that has been satisfied is “limited to evidence of the amount actually paid.” Keep every receipt. What you paid, and when, is the proof |
| A letter of protection | A provider treats now and is paid from the settlement. It is one route when a serious injury needs care the other options do not reach, and it is the one the law changed in 2023 |
What is a letter of protection, and what did the 2023 law change?
A letter of protection is a promise to pay a medical provider out of any settlement or judgment. Since March 2023, Florida requires it to be disclosed and limits how an unpaid bill can be proved.
Section 768.0427(1)(d) defines it as “any arrangement by which a health care provider renders treatment in exchange for a promise of payment for the claimant’s medical expenses from any judgment or settlement,” and says it counts “regardless of whether referred to as a letter of protection.” It is a real debt. The provider is a creditor, not a favor, and the amount owed is a matter of the contract you signed.
What has to be disclosed. Under subsection (3), a claim for medical expenses for treatment under a letter of protection cannot go forward until the claimant discloses the letter itself; every bill, itemized and coded; the name of any factoring company that bought the account and what it paid; whether the claimant had health coverage at the time of treatment; and whether the claimant was referred for treatment under a letter of protection and by whom. If the referral came from the claimant’s attorney, the statute says that fact is admissible and that the financial relationship between a law firm and a medical provider, “including the number of referrals, frequency, and financial benefit obtained, is relevant to the issue of the bias of a testifying medical provider.” Ask any lawyer you are considering whether they send clients to particular providers, and what that would mean for your case.
How an unpaid bill is proved. For a claimant with no health coverage, subsection (2)(b)3 makes admissible evidence of “120 percent of the Medicare reimbursement rate in effect on the date of the claimant’s incurred medical treatment or services,” or, where there is no Medicare rate for a service, 170 percent of the state Medicaid rate. That is the number the defense will put in front of a jury. But the list of admissible evidence in that subsection “shall include, but is not limited to” those figures, and paragraph (2)(b)5 separately allows “any evidence of reasonable amounts billed to the claimant for medically necessary treatment.” So the provider’s full bill is not erased. It is contested, and a provider whose charges are several times the Medicare rate is exposed to that contest.
What it does not say. The statute governs what evidence proves the amount of damages in a lawsuit. It does not, by its words, say what a provider may charge or collect from you under your own contract. A letter of protection should be read for what happens if there is no recovery, whether the provider can assign the debt, and whether the balance can be reduced at settlement. Those answers are in the letter.
Which cases it reaches. The act that created this section became law on March 24, 2023, and applies to “causes of action filed after the effective date of this act.” The date that counts is the date a suit is filed, not the date of the crash, so a crash from 2021 that has not been filed is evaluated under these rules. The same statute’s effect on what a claim is worth is in what is my injury case worth.
What mistakes cost people without insurance their claim?
Almost none of these are about the law. They are about the cost of care and what a gap looks like afterward.
| Not being seen within 14 days | PIP medical benefits are payable only for initial services received within 14 days. A person with no insurance who waits to see if the pain goes away can lose the coverage that was available |
| Stopping treatment because of the bill | Paul’s own list of what moves an insurer’s valuation includes emergency room treatment on the day of the crash and consistent treatment and symptoms. A gap reads as a sign you recovered. A gap caused by cost can be explained, but only if there is a record of why |
| Signing a letter of protection unread | It is a debt with terms. People sign it in a waiting room with a pen in their hand. Ask for a copy and read what happens if there is no recovery |
| Paying cash and keeping nothing | A bill that is satisfied is proved by what was actually paid. A payment with no receipt is a payment that cannot be shown |
| Assuming the emergency room bill will be canceled | The law lets you receive the care. It does not erase the bill. Ask about financial assistance, in writing, before the account goes to collections |
An illustration, not a prediction
A composite example of how cases like this typically go. Every case is different, and nothing here predicts a result.
A man with no health insurance is hit while riding through an intersection in West Palm Beach and taken by ambulance to an emergency department. No one asks about insurance. A physician documents an emergency medical condition, so his PIP carrier can reimburse up to $10,000 instead of $2,500, and the hospital bills PIP first. The ambulance sends a bill, and he signs the agreement the statute calls for.
Three weeks later the PIP money is nearly gone and his doctor wants an MRI and a course of physical therapy. He applies to the Health Care District’s sliding fee program for the primary care visit and asks the imaging center for its self-pay price in writing. An orthopedist agrees to see him on a letter of protection. He reads it first, learns the balance is owed whether or not the case recovers, and keeps a copy.
When the case is filed, the defense relies on the Medicare-rate evidence for the unpaid charges, and his side relies on what was actually paid and on evidence that the billed amounts were reasonable. What he nets depends on that dispute, on the policy limits, and on what comes back out of the recovery. The point is not the outcome. It is that each decision along the way was either documented or it was not.
What to gather
With no insurance the paperwork is the case, because it is the only record of what happened to you and what it cost.
| Every bill, with the date of service | The emergency room, the ambulance, imaging, each doctor. Including the ones you think PIP paid |
| Your PIP letters and payment log | Ask your own carrier in writing what it has paid, to whom, and what remains of the $10,000 |
| The emergency medical condition determination | Or the absence of one. It is the difference between $10,000 and $2,500 |
| Any letter of protection, or any form you signed to treat | A copy of each, signed, with the date |
| Receipts for everything you paid yourself | Cash, card, payment plan, pharmacy |
| Applications and answers on financial assistance | The Health Care District application, a hospital financial assistance request, and the reply, with dates |
| Collection letters, with the envelopes | A bill in collections while a claim is open is usually a coordination problem, not a debt you owe, and it is fixable |
Do you need a lawyer if you have no health insurance?
Sometimes you do not. Here is how to tell.
You probably do not need a lawyer if you had one emergency room visit, were released, your PIP paid it, the injury healed without further care, and nothing is in dispute. There is no claim to bring and no bill to negotiate.
You probably do need one if you need care you cannot pay for and the doctor wants a letter of protection; your PIP is exhausted or was capped at $2,500; a bill has gone to collections while your claim is open; the other driver is blaming you; the other driver has no insurance either; or you have been offered a settlement and no one has told you what has to come out of it. A free consultation costs one phone call, and it comes before you sign anything.
Common questions
Can an emergency room refuse me because I have no insurance?
No. Federal law requires a hospital with an emergency department to screen you and, if you have an emergency medical condition, to stabilize you or transfer you, and bars it from delaying either to ask about payment or insurance status. Section 395.1041(3) of the Florida Statutes says the same.
Will I still get a bill from the emergency room or the ambulance?
Yes. The duty is to provide emergency care, not to provide it free. For an ambulance, section 395.1041(3)(k)1 says the patient must execute an agreement to pay for the transport or supply insurance or credit information promptly afterward. Ask for the hospital’s financial assistance policy before you pay.
Does PIP pay if I have no health insurance?
Yes. PIP does not depend on health insurance. Section 627.736(1) pays 80 percent of reasonable, medically necessary expenses up to $10,000 if your first treatment is within 14 days of the crash, and covers the named insured, household relatives, the driver, passengers, and a person struck while not in a vehicle.
What if more than 14 days have passed since the crash?
PIP medical benefits are payable only for initial services and care received within 14 days, so you may not be able to use them. Your claim against the at-fault driver is a separate matter with a separate deadline, and it is not lost because PIP is. Call before assuming either one is gone.
Is there free or low-cost care in Palm Beach County?
The Health Care District of Palm Beach County runs community health centers with a sliding fee program based on family size and income, open to patients with or without insurance, and states that patients will never be turned away because they cannot pay. Its list of services does not name MRI, orthopedics or physical therapy, so ask what it can arrange for an injury.
Can I see a doctor on a letter of protection?
Some providers will. A letter of protection is a promise to pay from a settlement or judgment, and it is a real debt. Read it for what happens if there is no recovery and whether the balance can be reduced. Section 768.0427(3) requires the letter, the itemized bills and the referral source to be disclosed before a claim for those expenses goes forward.
Does the 2023 law limit my medical bills to 120 percent of Medicare?
Not exactly. For a claimant with no health coverage, section 768.0427(2)(b)3 makes evidence of 120 percent of the Medicare rate admissible to prove unpaid charges. But the list of admissible evidence is not limited to it, and paragraph (2)(b)5 also allows evidence of reasonable amounts billed. The statute is about evidence in a lawsuit, not about what a provider may charge you under your contract.
If there is no recovery, do I still owe the doctor?
It depends on what you signed. Many letters of protection make the balance owed whether or not the case recovers. Read it before you sign. That question is separate from the law firm’s own fee and case costs: the approved sentence on this site about owing nothing unless there is a recovery refers to attorney’s fees and the costs the firm advances, not to what a medical provider is owed.
Is there help with a hospital bill I cannot pay?
A hospital run by a tax-exempt organization must have a written financial assistance policy under 26 U.S.C. 501(r), limit what it charges an eligible patient to the amounts generally billed to insured patients, and make reasonable efforts to determine eligibility before taking extraordinary collection actions. Ask the billing office for the policy and the application, and keep the reply.
The other driver had no insurance either. Does my claim still work?
Your own PIP still pays first, and your uninsured motorist coverage, if you bought it, carries the rest of the claim. Florida uninsured motorist coverage and uninsured motorist claims explain how.
How Paul helps when you were hurt and have no insurance
Talk to Paul, before you sign anything
If you need treatment and do not know how it will be paid for, that is a conversation to have early, not at settlement. Paul R. Shalhoub will go through your options with you himself. Consultations are free and confidential. We advance case costs, and you owe no attorney’s fees or reimbursement of those costs unless we recover compensation for you.
Call (561) 208-5058 Free case review
Shalhoub Law Injury & Accident, 1011 N Olive Ave, West Palm Beach, FL 33401. This describes Florida and federal law as of November 12, 2026 and applies to claims in Florida. It is general information, not legal advice, and reading it does not create an attorney-client relationship. Past results do not guarantee or predict a similar outcome.