Will Medi-Cal reimburse me for co-pays or other costs?

Medi-Cal can help cover co-payments, especially when used as secondary insurance, so you may wonder if you can get reimbursed for co-payments you've paid to a provider. However, you cannot get reimbursed directly by Medi-Cal, unlike private insurance.

The provider needs to bill Medi-Cal, and then when the provider gets paid, they should refund you any overpayment. This only applies to providers who accept Medi-Cal; if the provider does not accept Medi-Cal, you will not receive any reimbursement because Medi-Cal does not offer any out-of-network coverage.

Any vendor or provider contracted with Medi-Cal has to bill Medi-Cal first; they cannot bill you until they bill Medi-Cal first, even if you request to pay privately. However, if Medi-Cal covers a specific service, the provider also cannot bill you for any remaining balance for that service after Medi-Cal has paid its share up to the contracted Medi-Cal rate.

If the provider refuses to refund and it’s something Medi-Cal should have paid for, you can call (916) 403-2007 to ask about Medi-Cal Out-of-Pocket Expense Reimbursement. This usually applies to payments for retroactive Medi-Cal benefits when authorized, or for services you paid for in between your Medi-Cal application date and the date you received your child's benefits card.