Out-of-network billing is governed by different laws depending on what kind of services are provided, where they are provided, and who the payor and their regulators are.
California’s out-of-network billing and payment law (AB 72), that took effect July 1, 2017, changed the billing practices of non-participating physicians providing non-emergent care at in-network facilities including hospitals, ambulatory surgery centers and laboratories, for commercial payors regulated by the California Department of Managed Health Care (DHCS) or the California Department of Insurance (CDI).
There is also federal law, the “No Surprises Act” (NSA), that took effect on January 1, 2022. This law changed the billing practices of non-participating physicians providing emergent and non-emergent care for patients enrolled in self-funded/ERISA insurance as well as emergent care for fully insured commercial products regulated by CDI.
These laws were designed to reduce unexpected medical bills for patients receiving covered services from out-of-network physicians.
The California Medical Association (CMA) is aware of the potential adverse impacts of these laws on our physician members and have dedicated significant resources to achieve the best possible outcomes for physicians. Below are resources CMA has developed to help physicians navigate these laws and their systems.