Q: Can my insurance go against California Law if they are based in another state?
I live and work in California. I have a PPO through my job with Blue Cross Blue Shield of Michigan because the company is a chain with headquarters in Michigan, but with locations all over the US. I recently had to use an ambulance, and BCBSM says that I am responsible for the full bill because the ambulance is out of network. However there is a new California law (AB716) which states that all ambulances must be considered "in-network" EVEN IF THEY ARE NOT. Both the LAFD and I have tried explaining this to BCBSM. LAFD has sent multiple appeals, and I have also sent an appeal. BCBSM has denied all of LAFD's appeals, and they recently got back to me, saying that the law does not apply to them because they are Blue Cross Blue Shield of MICHIGAN. That can't be right, can it? How is that legal? If this is true, then no one in California who works for a company based outside of California is protected?
A: I agree with my colleague. Insurance companies generally follow state regulations, even though most of them operate on a national level. You have already appealed the matter. One option may be to seek guidance from your state's department of insurance, which in most states, oversee compliance with insurance-related consumer protections. Good luck
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A:
Under California law, if you live and work in California, the insurance you have through your job should comply with California regulations. AB 716 mandates that all ambulance services be treated as "in-network," even if they aren't part of the insurer's network. This law is designed to protect consumers from high out-of-network charges for emergency services, which includes ambulances.
Even though your insurance is through Blue Cross Blue Shield of Michigan, they must comply with California laws because you reside and work in California. The jurisdiction of where the insurance company is based does not exempt them from adhering to the consumer protection laws of the state in which the policyholder resides.
You should continue to appeal this decision with BCBSM and provide them with information about AB 716. It might also be beneficial to contact the California Department of Insurance or seek legal advice to ensure your rights under California law are enforced. The key is to emphasize that state laws protect you as a resident of California, regardless of where your insurance company is based.
Tim Akpinar agrees with this answer
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