Billing Policy
Your Rights and Protections Against Surprise Medical Bills
Central Valley Mental Health
Last Updated: March 31, 2026
What is “balance billing” (sometimes called “surprise billing”)?
When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.
“Out-of-network” describes providers and facilities that haven’t signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called “balance billing.”
“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.
You are protected from balance billing for:
Emergency services
If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most the provider or facility may bill you is your plan’s in-network cost-sharing amount. You can’t be balance billed for these emergency services.
Certain services at an in-network hospital or ambulatory surgical center
When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers may bill you is your plan’s in-network cost-sharing amount.
You’re never required to give up your protections from balance billing. You also aren’t required to get care out-of-network. You can choose a provider or facility in your plan’s network.
When balance billing isn’t allowed, you also have the following protections:
- You are only responsible for paying your share of the cost (like copayments, coinsurance, and deductibles). Your health plan will pay out-of-network providers and facilities directly.
- Your health plan generally must cover emergency services without requiring prior authorization.
- Base what you owe on what it would pay an in-network provider.
- Count any amount you pay toward your deductible and out-of-pocket limit.
If you believe you’ve been wrongly billed
If you get a surprise bill for more than your in-network cost share, file a grievance with your health plan and include a copy of the bill. If the issue is not resolved, you can file a complaint with the Department of Managed Health Care.
Visit www.HealthHelp.Ca.Gov or call 1-888-466-2219.
Visit www.cms.gov/nosuprises/consumers or call 1-800-985-3059 for more information about your rights under federal law.
Central Valley Mental Health
Phone: 559-796-0001
Email: Info@cvmh.org
Certified by the State Department of Health Care Services
Certification Number: 20007AN
Expiration Date: 6/30/2027