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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.

June 2017 Archives

Physician Balance Bill?

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Question: I have Anthem Blue Cross silver 94 PPO. I had to visit to ER in March and I verified the facility was in network. I received a balance bill from the Doctor demanding me to pay what anthem did not pay. Do I have to pay this bill?

Answer: You are not alone. A recent Consumers Union survey found that one-quarter of Californians who had hospital visits or surgery in the past two years were charged an out-of-network rate when they thought their provider was in-network.

Emergency physicians in California are barred from "surprise" balance billing. Health plans pay non-contracting physicians the plan's average contracted rate or 125% of the Medicare rate, whichever is greater. Your insurer, Anthem can tell you what portion of the doctor's bill you are required to pay under your plan of coverage.

A new California law goes into effect on July 1, 2017 that extends the "no surprises" balance billing restrictions to non-emergency medical services. The bill, passed by the California General Assembly after months of tough negotiations, also tightens requirements on health plans to offer adequate provider networks.

Question: I'm 17, I'll be having my baby late July. As a minor, how can I apply for health insurance for me and my kid? Im currently unemployed and wont be able to work until next year. I also wont be turning 18 until 7 months after my baby is born. Im under my moms health insurance at the moment.

Answer: You can stay on your Mom's insurance and your newborn can be insured independently for about $150/mo with any health insurance company in California. If that rate is unaffordable, Medi-Cal is free if you qualify. Click here for ways to apply for Medi-Cal.

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