More and more in-network doctors across California are now charging mandatory out-of-network annual fees. Patients trying to stay with their current in-network doctor — or find a new one after long waits — are increasingly being told they must pay a mandatory annual fee of hundreds, sometimes thousands, of dollars out-of-pocket just to become or remain a patient.

These fees are not covered by insurance, not optional for special access, and simply not ethical. They reduce access to care for all—especially seniors, people with chronic conditions or fighting illness, and underserved communities. This practice is ethically questionable, financially exclusionary, and deeply frustrating for patients trying to find and establish care. Californians deserve better.

These fees are not for medical services or procedures. They’re typically justified with vague explanations — like “we need to cover administrative costs or high rent” or “insurance doesn’t reimburse us fairly.” But if a doctor chooses to stay in-network with insurance, it’s their professional obligation to honor that contract with patients — not pass their financial frustrations onto the public.

This is not about transparency. These fees would be unethical even if doctors shouted them from the rooftops — because patients are being asked to pay a second, out-of-pocket toll, despite being insured and “in-network.”

Further, these fees often appear only after patients try to book an appointment or transfer medical records—right in the middle of an already difficult search due to limited availability and long waitlists. They act as a financial gatekeeper, blocking those who can’t or won’t pay extra for care that should be covered.

These fees disproportionately impact patients from marginalized racial and ethnic groups and those with limited finances, worsening healthcare disparities. But it’s not just low-income individuals—regular families with budgets are also being priced out of routine care simply because they refuse to pay twice.

We, the undersigned, call on the California Department of Managed Health Care (DMHC), the California Department of Insurance (CDI), and other relevant regulators to 

We urge California regulators to:

• Ban mandatory annual fees charged by in-network doctors.
  Immediately investigate and halt this growing practice among healthcare providers.
• Hold accountable those who violate insurance contracts or exploit loopholes to undermine patient rights and protections.
• Enforce equitable access by prohibiting income-based barriers and discrimination in network care.
• Protect patients from dismissal or denial of care for refusing to pay non-covered fees.
• Investigate potential violations of insurance contracts and ethical standards by providers charging these fees.

How Patients and Ethical Practitioners Can Take Action:

While we call on regulators to step in, patients and practitioners have power too. If you encounter an in-network doctor charging mandatory annual fees just to remain or become their patient, you don’t have to accept it.  

Here’s how patients can take action:  

• Refuse to pay unfair annual fees. You have the right to walk away and find a provider who honors your insurance coverage.
• Speak out. Tell your doctor (and their office) why you’re leaving or won’t proceed. The more people speak up, the harder it becomes for providers to normalize this behavior.
• Spread the word. Use platforms like Yelp, Google Reviews, and Healthgrades to publicly share your experience — clearly noting when a doctor is charging mandatory out-of-pocket annual fees despite being in-network.
• Report concerns to the California Department of Managed Health Care or the Department of Insurance.
• Praise ethical doctors. Just as it’s important to warn others, it’s equally powerful to celebrate and recommend providers who refuse to take advantage of patients, especially those who respect the spirit and intent of insurance networks.

Patients aren’t the only ones who can make a difference — if you’re a healthcare provider who refuses to charge mandatory annual fees, you can help by:

• Speaking out among your peers to raise awareness about how these fees harm patients and violate the spirit of in-network care.
• Advocating within your professional community and medical organizations to push for clear rules and enforcement against this practice.
• Supporting patients who speak up and sharing resources to empower others.
• Leading by example by refusing to impose unethical fees and prioritizing equitable access to care.

Together, we can shift the conversation. No one should be forced to pay hundreds or thousands of dollars just to access care that’s supposed to be covered. Let’s be clear: this is not concierge care — it’s coercion. And it’s time for California to lead the way in saying no.