[CA] What are the consequences of refusing to pay a medical bill after being incorrectly told a provider was in-network?

Lexi, Chatbot

I understand that dealing with medical bills can be very stressful. Can you tell me what specific issues you are facing with the bill you are disputing?

Lexi, Chatbot

Have you already attempted to resolve this dispute directly with the medical provider or insurance company?

Lexi, Chatbot

Is there anything else the lawyer should know before I connect you? Rest assured they'll be able to help with your medical bill dispute.

Jon

Hello and thank you for reaching out! I’m Jon, a licensed attorney with over 13 years of experience, and I’m here to help. I understand legal matters can feel overwhelming, but you’re in good hands. I’ll do my best to make things clear and guide you toward the right solution for your situation.

I see you've been through quite a bit trying to resolve this issue. It's good that you've taken steps like sending registered letters. Could you tell me if you've received any written responses from the telehealth company or your insurance regarding your dispute? Also, do you have any documentation of the advice you were given about the network status?

Jon

It sounds like you've been through a lot trying to resolve this. Having documentation can really help in these situations. Do you have any written or recorded evidence of the advice you were given about the telehealth company being in-network?

Jon

Medical billing disputes can be overwhelming, and it’s completely understandable to feel frustrated when you’re dealing with them. I can walk you through some general information that may help you understand your situation better, but keep in mind this isn’t a substitute for legal advice. For personalized guidance, it’s important to reach out to an attorney in California who works with consumer law or medical billing disputes.

One of the most important laws in this area is the No Surprises Act, which went into effect on January 1, 2022. This law is meant to protect patients from being hit with unexpected medical bills, especially when care involves out-of-network providers.

For emergency services, and for certain non-emergency services provided by an out-of-network doctor at an in-network facility, you’re generally only responsible for your normal in-network costs like copays, deductibles, or coinsurance.

The law also prevents providers from billing you for out-of-network services unless they give you a clear estimate upfront and you agree to it. In your case, since both your insurance company and the telehealth provider told you the service was in-network, this could be an important factor in your dispute.

You also asked about what could happen if you don’t pay the full bill. Providers sometimes send unpaid balances to a collection agency, which can affect your credit. But as of January 1, 2025, federal law has changed so that medical debt under a certain amount—starting at $500—or medical debt that has been paid cannot be reported to credit agencies. (15 U.S.C. § 1681)

On top of that, if a provider or collection agency wanted to sue for the debt, they would need to go to court and win. That could result in a judgment, which might lead to wage garnishment or a lien on property. That said, lawsuits can be expensive and time-consuming, so providers don’t always pursue them, especially for smaller debts. (CA Civ Pro Code § 706.010)

Jon

California also has its own consumer protections when it comes to medical billing. The state has a version of the No Surprises law that sometimes provides even stronger safeguards than the federal law. In addition, California’s Health and Safety Code and Business and Professions Code contain rules about how providers can bill and collect payments.

As for next steps, you’ve already started by sending letters to the company. You might consider taking it further by filing a complaint with the California Department of Managed Health Care or the California Department of Insurance, depending on your insurance plan. These agencies have the power to look into disputes and sometimes resolve them.

But given how complicated your situation is and the amount of money involved, talking to a lawyer who specializes in medical debt or consumer protection is strongly recommended. A lawyer could review the details, explain your options, and help protect your rights. If cost is a concern, many local bar associations offer referral services that can connect you with affordable or even free initial consultations.

Jon

In California, a medical provider cannot garnish your wages without first suing you and getting a court judgment. Even then, there are limits on the amount they can take from your paycheck.

Jon

Great! Wishing you a fantastic day ahead!