DMHC Press Release

June 13, 2024 Press Release


Thursday, June 13, 2024


DMHC-Licensed Health Plans Must Follow Law Protecting Californians from Balance Billing

(Sacramento) – The California Department of Managed Health Care (DMHC) today issued guidance reminding health plans to comply with important consumer protections in California law designed to protect health plan members from the illegal practice of balance billing. Also called a surprise bill, balance billing happens when a health care provider bills a health plan member for a balance not paid by the health plan. Balance billing usually occurs when the health plan member has no control over who is involved in their care – such as for emergency services or when they have scheduled a visit at an in-network facility but, unexpectedly and unknowingly, receive treatment from a noncontracted provider.

“California law protects health plan members from the illegal practice of balance billing,” said DMHC Director Mary Watanabe. “The law takes consumers out of the middle of billing disputes between health plans and providers. We want Californians to know their health care rights, including protections from being illegally balance billed by a health care provider.”

BALANCE BILLING PROTECTIONS FOR CALIFORNIANS: The DMHC issued an All Plan Letter to health plans regulated by the Department. Health plans must comply with Assembly Bill (AB) 716 (2023) which protects health plan members from being balance billed by ambulance service providers not contracted with their health plan. The guidance reminds plans of the balance billing protections in the law, and about their obligations to reimburse noncontracted ground ambulance providers when services are provided to the plan’s members. Health plan members are only responsible for their in-network cost-sharing amount, such as a co-pay.

“The last thing anyone should be thinking about when they call 911 is whether they can afford the ambulance ride,” said Assemblymember Tasha Boerner (D – Encinitas), author of AB 716. “Californians with health care coverage no longer need to worry about an outrageous bill after an ambulance ride, giving millions of Californians peace of mind knowing they can make their copayment.”

California law also protects health plan members against balance billing for air ambulance services and health care services delivered by noncontracted providers at an in-network facility, like a hospital that is in-network with the member’s health plan.

WHAT HEALTH PLAN MEMBERS CAN DO: Health plan members who believe they have been illegally balance billed should file a complaint, also called a grievance, with their plan. If the health plan doesn’t fix the problem or takes more than 30 days to resolve the issue, members should file a complaint with the DMHC Help Center at or by calling 1-888-466-2219. More information about balance billing and what health plan members can do if they receive an illegal bill can be found in the DMHC’s Know Your Health Care Rights Fact Sheet on Balance Billing.


About DMHC:

The California Department of Managed Health Care (DMHC) protects the health care rights of 29.7 million Californians and ensures a stable health care delivery system. The DMHC Help Center has assisted 2.8 million Californians to resolve complaints and issues with their health plan. The DMHC Help Center provides assistance in all languages and all services are free. For more information visit or call 1-888-466-2219.