California Law Puts Limits On ‘Surprise’ Medical Bills

California law protects individuals from receiving unexpected ‘surprise’ medical bills from an out-of-network doctor when receiving inpatient and outpatient care at an in-network healthcare facility. A surprise medical bill, also known as balance billing, occurs when you go to a healthcare facility, like a hospital in your plan’s network, and end up with a doctor who is not in your plan’s network. As a result, you are charged more than you would have to pay for an in-network doctor.

If an out-of-network physician treats a patient at an in-network facility and does not obtain the patient’s consent to be treated by an out-of-network physician, then the physician will not be paid the full amount for his or her services from either the patient or the insurer.

If you get a surprise bill for more than your in-network cost share, file a grievance/complaint with your health plan and include a copy of the bill. Your health plan will review your grievance and should tell the provider to stop billing you for amounts greater than your in-network cost share.