Attorney General Bonta Reminds Californians of Legal Protections Against Balance Medical Billing

OAKLAND – California Attorney General Rob Bonta today issued a consumer alert reminding Californians of their legal rights protecting them against balance medical billing. California law protects consumers from balance medical bills by preventing patients from being billed for the difference between out-of-network provider charges and the amount the insurance company is willing to pay. Just last year, a federal law was passed to implement similar protections under the No Surprises Act.

“A healthcare emergency should not lead to a financial crisis. Yet too often, consumers are faced with high medical expenses when an unexpected accident or illness occurs,” said Attorney General Bonta. “With today’s consumer alert, we are reminding Californians that both state and federal law protects them against balance medical billing. At the California Department of Justice, we remain unwavering in our commitment to provide healthcare affordability and transparency to all Californians.”  

Balance billing occurs when a medical provider bills a patient for the difference between the amount the provider charges, and the amount the patient’s insurance allows. “Balance bills” typically occur in two circumstances: 1) when an enrollee receives emergency care either at an out-of-network facility or from an out-of-network provider, or 2) when an enrollee receives elective nonemergency care at an in-network facility but is treated by an out-of-network healthcare provider that the patient had no choice in selecting.

A variation of this practice is upfront balance billing. Upfront balance billing occurs when an in-network medical provider bills a patient before a procedure in anticipation the insurance company denies the claim for the procedure. In-network providers are required to bill insurance first before seeking the full cost of a claim from a patient. Consumers who receive care from in-network providers are only responsible for their in-network cost-sharing, such as co-pays, co-insurance, or deductibles. An in-network provider may not assume a denial of a claim by the insurer and upfront balance bill a consumer.

Patients who have received an upfront balance bill from a provider can file a consumer complaint on the Office of the Attorney General’s Consumer Complaint webpage at https://oag.ca.gov/contact/consumer-complaint-against-business-or-company.

Complaints can also be filed with the California Department of Managed Health Care at https://dmhc.ca.gov or with the California Department of Insurance at https://www.insurance.ca.gov/01-consumers/101-help/index.cfm 

Throughout his career, Attorney General Bonta has worked tirelessly to ease the burden of medical debt to Californians across the state. As Attorney General, he called on the federal government to safeguard patients from medical debt. Just last week, he issued a consumer alert reminding Californians of their right to access hospital price information. While serving in the California State Assembly, he authored AB 72 which protects consumers from balance billing by out-of-network providers. AB 72 prohibits out-of-network providers from reporting adverse information to a consumer credit reporting agency or commencing civil action against an enrollee before 150 days after the initial charge of their bill.