§ 10112.75
467 words·~2 min read·
/ca/insurance-code/10112-75A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
(a)If a health insurer sends payment for services provided directly to the insured and not to the provider, the insurer shall send notice to the insured and the provider who provided the services that the insurer has sent payment to the insured.
(b)The notice sent to the insured pursuant to subdivision
(a)shall include all of the following:
(1)The date the notice was sent and the name and address of the provider who billed for the service.
(2)A statement that if the insured has paid the full bill for the service, including both their cost-sharing and the insurer share of cost obligation, the actions described to collect the insurer obligated payment in paragraph
(3)do not apply, and that this check is for reimbursement of the consumer for paying the insurer share of cost obligation.
(3)Information about action that may be taken if the insured does not send the insurer’s obligated payment to the provider, including all of the following:
(A)That an unpaid bill may be sent to collections and the insured may be subject to collections.
(B)That the provider or debt collector may pursue litigation against the insured to collect the bill.
(C)That the unpaid insurer share of cost obligation may be reported to a credit reporting agency as medical debt if the provider does not receive the payment within 60 days of the notice, or within one year after initial billing for the service, whichever is later.
(c)The required notice sent to the provider pursuant to subdivision
(a)shall include the date that the notice to the insured was sent and the amount sent to the insured to reimburse the provider.
(d)If the provider does not receive the payment from the insured within 60 days of the notice to the insured, or within one year after initial billing for the service, whichever is later, the insurer’s share of cost in possession of the insured that has not been paid to the provider may be reported to a credit reporting agency as medical debt and shall not be considered medical debt for purposes of Sections 1785.13, 1785.20.6, 1785.27, and 1786.18 of the Civil Code if both of the following are true:
(1)The entity reporting the information has adequate documentation to substantiate that the insured actually received the funds from the insurer.
(2)The insured has not raised a dispute with the insurer, provider, or department as to whether the amount was received.
(e)This section does not limit existing requirements under this chapter protecting insureds from balance billing, including Sections 10112.8 and 10126.66.
(f)This section does not apply if the direct payment for services provided to the insured is a reimbursement from the insurer because the insured paid the insurer’s share of cost obligation.