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Cal. Health & Saf. Code § 1371.9

Section 1371.9 - In-network-cost-sharing amount
Section 1371.9 - In-network-cost-sharing amount

4 Analyses of this statute by attorneys

  1. No More Surprise Medical Bills: California Assembly Bill 72

    Manatt, Phelps & Phillips, LLPJohn LeBlancJune 22, 2018

    Under the Act, insured individuals are only responsible for costs equal to what they would pay if they received the service from an in-network provider. Cal. Health & Safety Code § 1371.9(a)(1). Further, out-of-network providers are prohibited from billing or collecting any amount from the enrollee for their services except for the in-network cost-sharing amount.

  2. California’s Departments of Managed Health Care and Insurance Publish Their Processes For Resolving Reimbursement Disputes Between Payors and Non-Contracted Individual Providers

    King & Spalding LLPNovember 7, 2017

    As described in our August Alert, California’s new “No Surprise” billing law required the California’s Department of Managed Health Care(“DMHC”) and Department of Insurance (“DOI”) to develop dispute resolution processes for handling rate disputes between health plans and individual health professionals (“IHPs”), including physicians and other clinicians who are not contracted with their patients’ health plans or insurers but who practice at hospitals and other facilities that are contracted, i.e., “in network.” See Cal. Health & Safety Code §§ 1371.9(f)(3), 1371.30; Cal.

  3. When your Hospital-of-Choice is In-Network but, SURPRISE, your Anesthesiologist is Not: California’s AB-72 and Other State Responses to the Surprise Billing Pandemic

    Sheppard, Mullin, Richter & Hampton LLPKenneth YoodJune 27, 2017

    The insurers and the physicians work out payment for services through a voluntary, state-arranged dispute resolution process. The law only applies to PPO plans since Florida already prohibits surprise out-of-network physician bills for HMOs.California’s Surprise Billing Protection Law – AB-72On July 1, 2017, California’s surprise billing protection law at Cal. Health and Safety Code § 1371.9 (2016) and elsewhere (“AB-72”), takes effect in California. As a result, healthcare facilities in the Golden State are scrambling to address the many AB-72 issues that will emerge on July 1, 2017.

  4. When your Hospital-of-Choice is In-Network but, SURPRISE, your Anesthesiologist is Not: California’s AB-72 and Other State Responses to the Surprise Billing Pandemic

    Sheppard, Mullin, Richter & Hampton LLPKenneth YoodJune 22, 2017

    The insurers and the physicians work out payment for services through a voluntary, state-arranged dispute resolution process. The law only applies to PPO plans since Florida already prohibits surprise out-of-network physician bills for HMOs.California’s Surprise Billing Protection Law – AB-72 On July 1, 2017, California’s surprise billing protection law at Cal. Health and Safety Code § 1371.9 (2016) and elsewhere (“AB-72”), takes effect in California. As a result, healthcare facilities in the Golden State are scrambling to address the many AB-72 issues that will emerge on July 1, 2017.