Protection From Surprise Medical Bills
California law protects patients from surprise medical bills.
What Is a Surprise Medical Bill?
A surprise medical bill, also known as balance billing, occurs when you go to a health care facility, like a hospital or a lab 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.
A surprise medical bill can also happen if you are taken to a non-contracted facility in an emergency, and the facility bills you for the remaining balance for services not covered by your health plan.
California law protects you from these types of surprise medical billing practices. Providers cannot bill patients more than their in-network cost sharing.
What You Should Pay
Patients who go to an in-network facility only have to pay for in-network cost sharing (co-pay, co-insurance or deductibles).
Patients taken to a non-contracted medical facility for emergency services will only be required to pay the in-network cost share.
Contact your health plan if you have questions about your in-network cost sharing.
What if I Get a Surprise Bill?
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.
If you do not agree with your health plan’s response or they take more than 30 days to fix the problem, you can file a complaint with one of the health-plan-regulation agencies listed below:
- For plans regulated by the Department of Managed Health Care, go online to HealthHelp.ca.gov or call 888-466-2219.
- For plans regulated by the California Department of Insurance, go online to insurance.ca.gov or call 800-927-4357.
- If you do not know the type of plan you have, please call the Department of Insurance Help Center at 800-927-4357.
For more information about your rights under federal law, visit cms.gov/nosurprises.
- Consumer Educational Guides — Healthcare Financial Management Association
- Price Transparency: Standard Charges and Price Estimates (UC San Diego Health)
Contact a UC San Diego Health customer services representative by: