Section 1367.11 Of Article 5. Standards From California Health And Safety Code >> Division 2. >> Chapter 2.2. >> Article 5.
1367.11
. (a) Every health care service plan issued, amended, or
renewed on or after January 1, 1987, that offers coverage for medical
transportation services, shall contain a provision providing for
direct reimbursement to any provider of covered medical
transportation services if the provider has not received payment for
those services from any other source.
(b) Subdivision (a) shall not apply to any transaction between a
provider of medical transportation services and a health care service
plan if the parties have entered into a contract providing for
direct payment.
(c) For purposes of this subdivision, "direct reimbursement" means
the following:
The enrollee shall file a claim for the medical transportation
service with the plan; the plan shall pay the medical transportation
provider directly; and the medical transportation provider shall not
demand payment from the enrollee until having received payment from
the plan, at which time the medical transportation provider may
demand payment from the enrollee for any unpaid portion of the
provider's fee.