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.