MedicaidReimbursementHigh impact
22-934 Medi-Cal Member Balance Billing is Prohibited
Health Net·CA·Reimbursement
We identified it
Jun 20, 2026
Summary
Health Net Medi-Cal has issued a reminder that balance billing Medi-Cal members is strictly prohibited. Providers cannot charge any fees beyond required copayments and coinsurance, and when Medicare is primary with Medi-Cal secondary, members cannot be charged any copayments, coinsurance, or deductibles.
Action Required
Immediately: Billing team must review all Medi-Cal member accounts to ensure no balance billing is occurring. Update billing system rules to prevent charging Medi-Cal members any fees beyond copayments/coinsurance. For dual-eligible members (Medicare primary/Medi-Cal secondary), configure system to never charge copayments, coinsurance, or deductibles. Train front desk staff on proper Medi-Cal billing procedures. Violations could result in contract termination and legal penalties.