Medical bill appeals in California.
How state appeal law and surprise-billing rules apply in California, and the errors we look for.
California's Knox-Keene Act adds patient protections beyond federal ERISA — including the right to an Independent Medical Review (IMR) by the Department of Managed Health Care after the insurer's internal appeal is exhausted. IMRs run free for the patient and decide in favor of the patient ~60% of the time.
AB-72 (effective 2017) banned surprise OON billing for non-emergency services at in-network facilities — California had this protection before the federal No Surprises Act. We typically cite both AB-72 and the NSA on appeals filed in CA.
- 01Anthem Blue Cross
- 02Kaiser Permanente
- 03Blue Shield CA
- 04Cigna
- 05Aetna
- Upcoded ER visits (especially Bay Area trauma centers)
- Anesthesia balance billing at in-network surgical centers
- Imaging studies billed twice (TC + 26 modifiers)
Got a California bill?
We file under both federal and CA-specific appeal procedures, whichever gives your case the strongest position. The audit is free.
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