Corte Madera, CA asked in Health Care Law for California

Q: I have a question about health insurance and the provider

My son saw a therapist who confirmed they are in network with our insurance, Anthem. Yesterday we received an email from the provider saying they have not received any payments from Anthem for the last 6 months (for every patient thru Anthem), and they received a letter from Anthem terminating their contract as of September 9th. The provider tells us Anthem owes them over $800 for my sons appts and over $200k for all their patients. I am worried the provider will send us a bill for the $800. We weren't expecting that since we were told they are in network. Anthem's website also shows them as in network. We cant afford to pay this amount and i'm very stressed that they will try to send it to us if they cant get it from Anthem. It seems to me like this should be between Anthem and the provider? Can the provider send us this bill and are we responsible for it??

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1 Lawyer Answer
James L. Arrasmith
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  • Estate Planning Lawyer
  • Sacramento, CA
  • Licensed in California

A: I would advise you to firstly confirm with Anthem directly regarding the status of your provider's network status and the payments in question. Secondly, under California law, healthcare providers generally are not allowed to bill patients directly for services that are covered by their insurance — this is referred to as "balance billing." However, it's important to review your insurance policy and possibly consult with an attorney who focuses on health care law to understand fully your potential liability in this situation.

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