California Balance Billing Laws and Protections

In California, patients have rights to protect themselves from surprise medical bills. Patients can't be charged more than the in-network cost-sharing amount for emergency services, even if the emergency provider isn't part of their insurance network.

California law requires health insurance companies to cover emergency services without prior authorization, and patients can't be required to pay more than the in-network cost-sharing amount for these services. This protection applies to all emergency services, including air ambulance services.

The state's law also prohibits balance billing for emergency services, which means patients can't be charged more than the in-network cost-sharing amount for these services. This protection helps patients avoid surprise medical bills and financial hardship.

Under the No Surprises Act, you're protected from surprise medical bills in certain situations. Emergency services, such as those you'd receive in a life-threatening situation, can't be balance billed, even if the provider is out-of-network.

If you receive emergency services from an out-of-network provider, you'll only be charged your plan's in-network cost-sharing amount. This includes services you may get after you're in stable condition, unless you give written consent to be balance billed for those post-stabilization services.

California state law has similar protections to the federal No Surprises Act, offering you additional safeguards against surprise medical bills. You can find more information about California's protections on the California Department of Managed Care Surprise Medical Bills Fact Sheet.

If you receive services at an in-network hospital or ambulatory surgical center, certain out-of-network providers, such as emergency medicine or radiology services, can't balance bill you. They may not even ask you to give up your protections against balance billing.

The No Surprises Act is a law that aims to protect Californians from unexpected medical bills. Out-of-network providers can bill you for the difference between what your plan pays and the full amount charged for a service, which is called balance billing.

This balance billing can be thousands of dollars, depending on the procedure or service. You may have additional costs or have to pay the entire bill if you see an out-of-network provider.

Surprise billing happens when you can't control who is involved in your care, like in an emergency or when you're treated by an out-of-network provider at an in-network facility. This can be a huge financial burden.

You may have to pay more for the same service if you see an out-of-network provider. This amount might not count toward your plan's deductible or annual out-of-pocket limit.

The No Surprises Act aims to prevent these surprise medical bills by setting limits on how much out-of-network providers can charge.

Surprise billing is a type of balance billing that occurs unexpectedly, often in emergency situations or when you're treated by an out-of-network provider at an in-network facility.

You can't control who's involved in your care, and surprise medical bills can cost thousands of dollars depending on the procedure or service.

Emergency services are protected from surprise billing, and out-of-network providers can't bill you more than your plan's in-network cost-sharing amount.

This includes services you get after you're in stable condition, unless you give written consent and give up your protections.

You're never required to give up your protections from balance billing, and you can choose a provider or facility in your plan's network.

Certain services at in-network hospitals or ambulatory surgical centers may be provided by out-of-network providers, but they can't balance bill you more than your plan's in-network cost-sharing amount.

These providers include emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services.

You're not required to get out-of-network care, and California state law has similar protections to the federal No Surprises Act.

You're responsible for ensuring your hospital or physician's bill is paid, so be sure to bring your insurance card with you to the office.

You may receive separate bills from physicians who are independent from the hospital, so check the hospital's Accepted Health Plans page to see if your insurance plan covers care from these physicians.

If you file an appeal with your health insurance company, notify the hospital immediately so they can be aware of any potential delays in payment.

To apply for Medi-Cal or State County Medical Services Plan (CMSP), contact Solano County Health & Social Services at (800) 400-6001 or visit your local office to apply within the same month you received service.

If you're denied Medi-Cal or State CMSP, contact the hospital's Financial Counseling Department at (707) 646-5637 to see if you qualify for the Financial Assistance program or Uninsured Discount Program.

Surprise medical bills can be a huge financial burden. This type of bill is called "surprise billing" because it's unexpected and often occurs in emergency situations.

You might be treated by an out-of-network provider even if you're at an in-network facility, leading to a surprise bill. This can happen when you're unable to control who's involved in your care.

You could end up paying thousands of dollars for a procedure or service, depending on what you need. This amount is likely more than what you'd pay for the same service from an in-network provider.

Surprise medical bills can be stressful and overwhelming, but it's essential to understand what's happening and your options for dealing with them.