Under the Knox-Keene Act of the State of California, the patient to whom services were provided is not liable for any portion of the bill, except for copays or non-benefit items, if applicable. The provider should not bill the patient or accept collection against the patient. The applicable regulation is 1379 of the Knox-Keene Act.
AB72/Cal. H&S Code State of California prohibits surprise billing for services rendered to Commercial members by non-contracted providers in a contracted facility.
Providers have a right to file a formal dispute regarding a claim or contract. For instructions on submitting a formal dispute, call Customer Service listed on your Remittance Advice. Mail disputes to: Provider Disputes, PO Box 211624, Eagan MN 55121. For electronic instructions and submission, visit Sutter Link. Check your claim's status online.
Effective January 1, 2010, the Centers for Medicare & Medicaid Services (CMS) expanded its current provider payment appeal process for appeals between non-contracted and deemed providers and Private Fee for Service Plans (PFFS) to include disputes between non-contracted providers and all of the following:
- Medicare Advantage Organizations (HMO, PPO, RPPO and PFFS)
- 1876 Cost Plans
- Medi-Medi Plans
- Program of All-Inclusive Care for the Elderly (PACE) organizations