California · Hospitalist
Dispute a hospitalist services at an in-network facility surprise bill in California
Hospitalist services delivered during an in-network admission are protected under the NSA. In California, additional state-level protections apply.
What the law says
California Health & Safety Code § 1371.9, enacted by AB-72, independently bars an out-of-network individual provider at an in-network facility from billing or collecting from an enrollee any amount other than the in-network cost-sharing amount. This protection applies in addition to, and is not preempted by, the federal No Surprises Act (42 U.S.C. § 300gg-111 et seq.).
- Cal. Health & Safety Code § 1371.9 (AB-72)
- 42 U.S.C. § 300gg-111 et seq. (No Surprises Act)
Your options
- Dispute the bill in writing before paying anything. The provider must respond and cannot send the bill to collections during the dispute.
- Notify your health insurer that an apparent NSA-protected service has been balance-billed. Ask them to adjudicate at the in-network cost-sharing amount.
- File a complaint with the federal No Surprises Help Desk at CMS if either party refuses to comply.
- If unresolved, you can invoke the patient-provider Independent Dispute Resolution (IDR) process for an external decision.
Other bill types in California
- Emergency room services
- Anesthesiology at an in-network facility
- Lab or pathology at an in-network facility
- Radiology at an in-network facility
Hospitalist bills in other states
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