MedicaidAdministrativeHigh impact
23-793 Prohibited Balance Billing for Medi-Cal Members
Health Net·CA·Reimbursement
We identified it
Jun 20, 2026
Summary
Health Net has issued a fresh reminder that providers cannot balance bill Medi-Cal members for any fees, copayments, coinsurance, or deductibles beyond required share-of-cost amounts. When Medi-Cal is secondary coverage, the primary plan's cost-sharing is covered by Medi-Cal and cannot be collected from members.
Action Required
Immediately: Review all Medi-Cal member accounts to ensure no balance billing is occurring. Billing team must verify that no copayments, coinsurance, or deductibles are being collected from Medi-Cal members except when share-of-cost applies. Update billing system rules to prevent charging Medi-Cal members when Medi-Cal is secondary coverage. Train front desk staff to identify Medi-Cal coverage and avoid collecting inappropriate payments.