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21-573m Reminder about Balance Billing Members for Covered Services
Health Net·CA·Reimbursement
We identified it
Jun 20, 2026
Summary
Health Net reminds providers that balance billing members for covered services is strictly prohibited by law and contract. Providers can only collect applicable copayments, coinsurance, and deductibles, and cannot pursue collection actions for denied covered services.
Action Required
Immediately: Billing team must review all patient billing practices to ensure no balance billing occurs for Health Net covered services. Stop any collection efforts for denied covered services. Update billing staff training to emphasize only copays, coinsurance, and deductibles can be collected from members. Ensure written agreements are obtained before providing non-covered services to members.