California Medical Bill Rights

42 U.S.C. § 300gg-111 (No Surprises Act)

Federal law (effective January 1, 2022) prohibits surprise out-of-network bills for emergency services, air ambulance services, and most non-emergency services at in-network facilities. Patients owe no more than the in-network cost-share. Providers and insurers must resolve payment disputes through Independent Dispute Resolution, not by billing the patient.

Cal. Health & Safety Code § 1371.4 (Emergency Services Balance-Billing Protection)

California prohibits non-contracted providers at in-network facilities from balance-billing patients for non-emergency services. Patients owe only the in-network cost-sharing amount; the provider and insurer must resolve the remainder through state Independent Dispute Resolution.

26 U.S.C. § 501(r) (Nonprofit Hospital Financial Assistance Requirement)

Federal law requires every nonprofit (501(c)(3)) hospital to maintain a written Financial Assistance Policy, publicize it widely, and screen all uninsured/underinsured patients for eligibility before sending unpaid bills to collections. Patients eligible for assistance cannot be charged more than the Amounts Generally Billed (AGB) to insured patients. Applies to roughly 3,000 nonprofit hospitals (about 58% of all US hospitals, 80% of beds).

Cal. Health & Safety Code § 127400 et seq. (Hospital Fair Pricing Act)

California hospitals must offer discounted or free care to uninsured patients earning at or below 400% of the federal poverty level. Hospitals must screen all uninsured patients for eligibility and cannot send unpaid bills to collections without first determining eligibility.

15 U.S.C. § 1692 et seq. (Fair Debt Collection Practices Act)

Federal law restricts how third-party debt collectors may contact consumers about medical or other debts. Consumers may demand written validation of any debt within 30 days of first contact; collectors must cease communication if requested in writing; harassment, deception, and unfair practices are prohibited.

Cal. Code Regs. tit. 28, § 1300.68 (Independent Medical Review)

California patients have 180 days from a denial decision to file for Independent Medical Review through the Department of Managed Health Care. The IMR is free and binding on the insurer.

Cal. Health & Safety Code § 1339.585

California hospitals must provide an itemized statement of charges, in plain language, within 10 working days of a written request. The bill must distinguish charges by department and include all CPT/HCPCS/DRG codes billed.

Cal. Civ. Code § 1785.13.7 (SB 1061)

Effective January 1, 2025, California prohibits consumer credit reporting agencies from reporting medical debt on consumer credit reports. Medical providers cannot furnish medical-debt information to a credit reporting agency.