Can You Dispute an ER Bill in California?

If you received a large emergency room bill in California and assumed you had no choice but to pay it, you may be leaving significant money on the table. California patients have three separate layers of legal protection against surprise ER and hospital bills — a state-level law (AB 72) that pre-dates the federal No Surprises Act, a state enforcement agency (the Department of Managed Health Care), and a hospital fair billing program enforced by the Department of Health Care Access and Information (HCAI). Here's what each one covers and how to use them.

Layer 1: The Federal No Surprises Act (For Most Insured Patients)

The No Surprises Act, effective January 1, 2022, bans balance billing for emergency care at any hospital, regardless of whether it is in your insurance network. If you have job-based insurance, an ACA marketplace plan, or individual insurance, the most you can be charged for ER services is your in-network cost-sharing — your copay, deductible, or coinsurance at the in-network rate.

• What this means practically: If you went to an out-of-network ER, or if an out-of-network physician (like an ER doctor, anesthesiologist, or radiologist) treated you at an in-network facility without your choice, they cannot send you a bill above your in-network cost.
• How to dispute it: Contact your insurer and tell them the charge is subject to No Surprises Act protections. They must process it at in-network rates. If the provider still pursues the balance, file a complaint at the federal No Surprises Help Desk: 1-800-985-3059 or cms.gov/medical-bill-rights.
• Good Faith Estimate disputes: If you were uninsured or self-paying, providers must have given you a Good Faith Estimate before scheduled care. If your final bill is or more above that estimate, you can file a dispute within 120 days of receiving the bill. The federal dispute process is at cms.gov/medical-bill-rights.

Layer 2: California AB 72 (For DMHC-Regulated Plans)

California's AB 72, effective July 1, 2017, provides independent state-level protection against surprise balance billing — and it covers situations the federal law was designed to address years later. Under AB 72, if you received covered services at a contracting (in-network) health facility from an out-of-network individual health professional, you pay no more than your in-network cost-sharing. The provider must accept whatever the health plan pays as payment in full.

• Who AB 72 covers: Enrollees in plans regulated by the California Department of Managed Health Care (DMHC) — this includes most commercial HMO and PPO plans regulated under California law. If you are in a self-insured employer plan (ERISA plan), AB 72 may not apply — your plan is regulated at the federal level, and your primary protection is the No Surprises Act.
• Emergency services note: AB 72's text focuses on non-emergency services. For emergency services, California Health and Safety Code and existing DMHC regulations independently protect enrollees from balance billing — your rights for emergency care predate both AB 72 and the federal No Surprises Act.
• How to dispute under AB 72: Contact your health plan first. If the plan does not resolve the issue within 30 days, file a complaint with the DMHC Help Center at www.dmhc.ca.gov or by calling 1-888-466-2219. The DMHC has independent medical review and Independent Medical Review (IMR) authority to enforce AB 72.

Layer 3: California's Hospital Fair Billing Program (For All Patients)

Regardless of your insurance status, California's Hospital Fair Pricing Act (Health and Safety Code § 127400 et seq.) requires every hospital to have charity care and discount payment policies. The Department of Health Care Access and Information (HCAI) enforces these requirements and operates a Hospital Bill Complaint Program to investigate violations.

• Charity care (financial assistance): All California hospitals must offer financial assistance to qualifying patients. Income eligibility thresholds vary by hospital, but state law requires coverage for patients below a specified income level. Many hospitals extend assistance to patients with moderate incomes who face large bills relative to their resources. You do not need to be uninsured to apply — if you have insurance but your out-of-pocket balance is significant, you may still qualify.
• 2025 updates — AB 2297 and SB 1061: As of January 1, 2025, California law was updated to prohibit hospitals from considering your monetary assets when determining charity care eligibility, to ban requirements that you apply for other coverage before receiving a discount, and to allow alternative documentation of income beyond tax returns or paystubs. These changes make qualification more accessible.
• How to apply for charity care: Call the hospital billing department and ask for the Financial Assistance Policy (FAP) application. The hospital must tell you about this program — if they didn't, that may itself be a violation you can report to HCAI. Submit the application with any required income documentation. The hospital must notify you of its decision and give you an opportunity to appeal a denial.
• HCAI complaint process: If a California hospital has not properly disclosed its financial assistance policy, has sent your account to collections prematurely, or has billed you in violation of the fair billing law, you can file a complaint with HCAI at hcai.ca.gov.

What to Do Step by Step

1. Request an itemized bill. Do not pay a summary bill. Ask for a line-by-line itemized statement. Review for duplicate charges, services not received, or billing codes that don't match your care. See how to find common billing errors.
2. Check your Explanation of Benefits (EOB). If you have insurance, your insurer should have processed the claim first. A large gap between what the insurer paid and what you're being billed may indicate balance billing in violation of AB 72 or the No Surprises Act.
3. Contact your health plan. Tell them you believe the charge may constitute improper balance billing. Ask them to reprocess the claim at in-network rates if applicable.
4. Apply for charity care if applicable. If the bill reflects a legitimate cost-share but is still unaffordable, ask the hospital for the FAP application immediately. Under California law, hospitals cannot send your bill to an outside collection agency until they have first notified you about financial assistance and given you a reasonable opportunity to apply.
5. File a DMHC complaint if your plan is unresponsive. Go to www.dmhc.ca.gov or call 1-888-466-2219.
6. File an HCAI complaint if the hospital violated fair billing rules. Go to hcai.ca.gov.

Related guides

• The No Surprises Act explained — what it covers and what it doesn't
• How to apply for charity care from a hospital
• Can you dispute a hospital bill? What the law actually says

This article is for informational purposes only and does not constitute legal advice.