Balance Billing

What If I Get a Bill from a Health Care Provider?

You may receive medical bills that you do not have to pay.

 

What should I know about improper billing?

If you have Medicare and Medi-Cal, health care providers and health plans cannot charge you for your health care costs. Charging you is called improper or “balance billing” and is illegal under both federal and state law.

  • Under the law, you cannot be charged for co-pays, co-insurance, or deductibles.

There are some exceptions, see below.

What should I do if I get a bill from by one of my health care providers?

  1. Do not pay the bill.
  2. Contact your health plan immediately to deal with the issue. You can also contact HICAP at 1-800-434-0222 to get help.
  3. Contact your health care provider and tell them that you have Cal MediConnect and should not be billed. Tell them to contact your health plan.

Your provider must take immediate action to fix the issue. They must stop the bill collection process and work with credit reporting agencies to correct any issues caused by billing you.

The only times they are allowed to charge you are:

  1. Co-pays for prescription drugs.
  2. Some Medi-Cal beneficiaries need to pay a monthly share-of-cost. For information about share-of-cost, call your county Medi-cal office.

Why would a provider bill me for services?

As the responsibility for paying for your health care switches from Medicare to your Cal MediConnect health plan, providers may bill you incorrectly. The state is educating providers to prevent incorrect billing.

To learn more about balance billing, you or your provider can call the Cal MediConnect Ombudsman at 1-855-501-3077.