Overview
California AB 72 (2017) established state surprise billing protections that now work in tandem with the federal No Surprises Act. Emergency services must be covered at in-network rates. OON providers at in-network facilities cannot charge more than in-network cost-sharing. Independent dispute resolution resolves rate disagreements.
Key Requirements
| Protected Scenario | Patient Responsibility |
|---|---|
| Emergency service (any provider) | In-network cost-sharing |
| OON provider at in-network facility | In-network cost-sharing |
| Disputed OON rate | Subject to IDR |
- Emergency services are protected from surprise billing under AB 72 and federal NSA.
- OON providers at in-network facilities cannot charge more than in-network cost-sharing.
- Plans must have independent dispute resolution processes for rate disagreements.
- Patients can file complaints with DMHC or CDI within 180 days of claim date.
- Combined state and federal protections apply; patient benefits from strongest protection in each scenario.
Penalties and Enforcement
DMHC and CDI enforce AB 72 surprise billing violations with fines, license sanctions, and consumer restitution orders. Plans and providers that engage in systematic surprise billing face regulatory action. Enforcement investigations often result in significant penalties and corrective action mandates.
Appeals and Exceptions
Disputed surprise billing charges can be appealed to DMHC or CDI for regulatory review. Independent dispute resolution is available for rate disagreements. No exceptions exist for emergency services or OON facility scenarios.
Interaction with Federal Law
California AB 72 provides state-level protections that work with the federal No Surprises Act. Both cover emergency and OON facility services. California enforcement is often more aggressive. Patients benefit from whichever protection is stronger in each scenario.
Common Questions
What protections does California AB 72 provide for surprise billing?
AB 72 protects emergency services and OON providers at in-network facilities. Combined with federal NSA, California patients have broad surprise billing protection.
How are surprise billing disputes resolved in California?
Through independent dispute resolution between the plan and OON provider. DMHC or CDI oversees the process and ensures fair rates.
Track California Surprise Billing Protections
Altair monitors AB 72 and federal NSA protections, identifying surprise billing exposures. See how it works.
State laws change. This reference is current as of 2026-04-06. Consult California AB 72 or a healthcare attorney for definitive guidance.