Bill > AB787

This bill requires health care service plans and health insurers in California to include a specific statement in their provider directories informing enrollees or insureds how to request assistance in finding an in-network provider and understand their rights regarding out-of-network coverage. The statement must be prominently displayed and include language advising people they can designate a request as urgent or non-urgent, with urgent requests requiring a response within two business days and non-urgent requests within five business days. When contacted, the health plan or insurer must acknowledge the request within one business day and provide a list of in-network providers confirmed to be accepting new patients. The list must include the date the providers were confirmed and a disclaimer that provider availability can change. The bill also requires health plans and insurers to maintain more accurate and up-to-date provider directories, with weekly online updates and quarterly printed updates. If an enrollee reasonably relies on inaccurate directory information, the regulatory department may require the plan or insurer to cover services and reimburse the enrollee as if the provider was in-network. The bill applies to various types of health plans, including Medi-Cal managed care plans, and imposes potential penalties for non-compliance, such as delayed payments to providers who do not update their directory information.

Budget and Finance, Health and Social Services

https://leginfo.legislature.ca.gov/faces/billStatusClient.xhtml?bill_id=202520260AB787