MedicaidAdministrativeHigh impact
25-457 Reminder: Balance Billing Medi-Cal Members is Prohibited
Health Net·CA·Reimbursement
We identified it
Jun 20, 2026
Summary
Health Net reminds providers that balance billing Medi-Cal members is strictly prohibited under federal and state law. Providers cannot charge Medi-Cal members copayments, deductibles, coinsurance, or any fees for covered services, and must bill fee-for-service Medi-Cal when managed care coverage is on hold.
Action Required
Immediately: Billing team must stop charging Medi-Cal members any copayments, deductibles, or coinsurance for covered services. Update billing system rules to prevent balance billing charges. Train front desk staff to verify if patients have multiple insurance plans and ensure Medi-Cal secondary patients are not charged any out-of-pocket costs. Non-compliance will result in disciplinary action and penalties under Provider Participation Agreement.