Balance Billing Laws in California
Your medical billing rights and protections in California.
California has strong state-level balance billing protections under the California Health and Safety Code sections 1317.1-1317.4 and the Knox-Keene Act. AB 72 (2016) and SB 510 (2021) provide comprehensive protections, limiting what out-of-network providers can bill patients in emergency and certain non-emergency situations to in-network cost-sharing amounts.
Key Protections in California
Emergency services: Under AB 72, emergency care patients are only responsible for their in-network cost-sharing; providers must accept the health plan's payment as full payment
Out-of-network at in-network facility: AB 72 prohibits balance billing for non-emergency services at in-network hospitals when the patient did not have a choice of provider
Dispute resolution: California's DMHC Independent Medical Review process is available; independent dispute resolution is handled through the state process
Broader network: California's Knox-Keene Act requires HMO plans to maintain adequate networks to reduce likelihood of involuntary out-of-network care
Filing Information
Within 180 days of receiving the bill for state-level disputes; federal NSA disputes within 1 year
Additional Notes
California has one of the strongest surprise billing frameworks in the country. DMHC oversees HMOs; CDI oversees other health insurance products. Consumers should file with the appropriate agency depending on their plan type. SB 510 further strengthened protections effective January 1, 2022.
How to File a Complaint in California
Gather Your Documentation
Collect your itemized medical bill, Explanation of Benefits (EOB) from your insurer, any prior authorization documents, and written communications with the provider or insurance company.
File with the State Regulator
Submit your complaint to the California Department of Managed Health Care (DMHC) and California Department of Insurance (CDI). Include all supporting documents and a clear description of the billing dispute.
File complaint with California Department of Managed Health Care (DMHC) and California Department of Insurance (CDI)File with CMS if Federal Protections Apply
If your dispute involves the No Surprises Act (emergency care or out-of-network providers at in-network facilities), you can also file directly with the Centers for Medicare & Medicaid Services.
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