MedicaidAdministrativeMedium impact
21-575m Reminder about Balance Billing Members for Covered Services
Health Net·CA·Reimbursement
We identified it
Jun 20, 2026
Summary
CalViva Health and Health Net remind providers that balance billing members for covered services is strictly prohibited by law and provider agreements. Providers can only collect applicable copayments, coinsurance, and deductibles, and cannot pursue collection actions for denied covered services.
Action Required
Immediately: Review current billing practices to ensure no balance billing of CalViva Health members beyond copays, coinsurance, and deductibles. Billing team must verify that collection procedures exclude covered services and only pursue collections for applicable cost-sharing amounts. For non-covered services, ensure written member agreement is obtained before providing services.