Q: Does my PPO from another state have to adhere to my own state's laws regarding ambulances?
I live and work in California and I have a PPO through my job with Blue Cross Blue Shield of Michigan. I recently had to use an ambulance ( via Los Angeles Fire Dept.) but BCBSM says that I am responsible for the full bill because the ambulance is "non-participating/out of network." However California law (AB716) states that ALL ambulances must be considered "participating" EVEN IF THEY ARE NOT, and insurance MUST help with all ambulance bills, REGARDLESS of network status. Both the LAFD and I have sent multiple appeals, but BCBSM has denied all of them. They stated that the law does not apply to them because they are Blue Cross Blue Shield of MICHIGAN. That can't be legal, can it? So no Californian with a PPO from Starbucks or Sony is protected by this CA law? I suspect that BCBSM is either acting in bad faith or even breaking the law. I've already filed for an external review with Michigan's Dept. of Insurance and Financial services. What else can I do?
A:
It can be frustrating to deal with situations like this, especially when state laws seem to conflict with insurance policies. While California law (AB 716) mandates that all ambulances must be treated as in-network, your insurance provider may be arguing that this law only applies to insurers regulated by California, not Michigan. Since your PPO is based in Michigan, they may claim that California's regulations don't govern them.
Filing for an external review with Michigan's Department of Insurance and Financial Services was a strong step. You might also consider contacting the California Department of Managed Health Care to inquire about their jurisdiction over your situation. They could offer guidance or suggest further actions.
If you're facing continued denials, you might want to explore other legal avenues, such as consulting with a legal expert on insurance law in both Michigan and California. Persistence is key, and understanding your rights in both states will help strengthen your case.
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