Speak with a Covered California certified agent! Call (888) 413-3164 or Shop Online Now

Shop and Compare

California Health Insurance Plans and Rates

It's easy. Just enter your zip code.

Covered California Q&A

Covered California and Obamacare related questions from consumers, employers and agents are answered by Phil Daigle with the best information available at the time. Archived entries may no longer be accurate as the Covered California and Obamacare knowledge-base is evolving quickly. TO REQUEST A PERSONAL RESPONSE INCLUDE EMAIL ADDRESS.


Using a Doctor Not in Network?

By on | No Comments

Question: What happens if I end up needing care from a doctor who isn’t in my health plan’s network?

Answer: Insurers are not required to cover any care received from a non-network provider, though all PPO plans sold in California today do, at least to some extent. If you do receive care out of network, it could be costly for you. Generally plans that provide an out-of-network option cover such care at a lower rate (e.g., 80% of in-network costs versus only 50% of non-network costs.) In addition, insurers are not required to apply your out-of-network costs to the annual out-of-pocket maximum. Non-network providers also are not contracted to limit their charges to an amount the insurer says is reasonable, so you might also owe “balance billing” expenses.

Leave a comment

Do You Have California Health Insurance Questions?

Ask An Expert

View Previous Questions
Call Us at (888) 413-3164


© 2019 California Health Benefit Advisers, LLC
Home / About / Start Shopping / Ask a Question

“Covered California,” “California Health Benefit Exchange”, and the Covered California Logo are registered trademarks or service marks of Covered California, in the United States. This web site is owned and maintained by California Health Benefit Advisers, LLC, which is solely responsible for its content.