The Alliance would like to remind all network providers that balance billing Medi-Cal beneficiaries is prohibited by federal and state law. Medi-Cal beneficiaries should not pay for physician visits and other medical care when they receive covered services from a provider in their provider network. This means beneficiaries cannot be charged for co-pays, co-insurance or deductibles. This applies to both Medicare and Medi-Cal providers.
If balance billing is discovered or suspected, the Alliance will promptly coordinate with providers to provide appropriate training and to ensure compliance with state and federal laws.
Billing Medi-Cal beneficiaries violates Federal law as outlined in section 1902(n)(3)(B) of the Social Security Act, as modified by section 4714 of the Balanced Budget Act of 1997 as well as California Welfare and Institutions Code section 14019.4.