California’s Departments of Managed Health Care and Insurance Publish Their Processes For Resolving Reimbursement Disputes Between Payors and Non-Contracted Individual Providers

King & Spalding

This bulletin is a follow-up to the August, 2017 King & Spalding Client Alert, “California’s Surprising New ‘No Surprise’ Health Care Billing Law” (“August Alert”).

As described in our August Alert, California’s new “No Surprise” billing law required the California’s Department of Managed Health Care(“DMHC”) and Department of Insurance (“DOI”) to develop dispute resolution processes for handling rate disputes between health plans and individual health professionals (“IHPs”), including physicians and other clinicians who are not contracted with their patients’ health plans or insurers but who practice at hospitals and other facilities that are contracted, i.e., “in network.” See Cal. Health & Safety Code §§ 1371.9(f)(3), 1371.30; Cal. Ins. Code §§ 10112.8(f)(3), 10112.81 (“AB 72”). The DMHC and DOI have now developed their AB 72 processes, which differ in significant ways.

Please see full alert below for more information.

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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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