Question: With the much narrower networks in all EPO/PPO plans the chances of an out-of-network provider providing services to me on ER are high. Seems like in California, balance billing, where the out-of-network provider charges you the difference between what insurance pays and whatever rate they may please, has been banned for HMO plans since 2008. It is not so clear to me what is going on for PPO/EPO plans. Seems like consumers from PPO/EPO plans licensed by the California Department of Managed Health Care can't be subject to balance billing on ER visits according to this http://goo.gl/bqZBgf. Any idea if using the plans on Covered California one would not be subject to balance billing on ER visits?
Answer: No. Qualified health plans offered through Covered California are underwritten by private insurance companies licensed by the California Department of Managed Health Care or the California Department of insurance and as such all Covered California HMO, EPO, and PPO plans are subject to restrictions against out-of-network providers balance billing for emergency room services (not including ambulance services).