Arizona Laws 20-3117. Dispute resolution; notice of rights
A. The department in conjunction with the appropriate health care boards shall prescribe the notice outlining an enrollee‘s rights to dispute surprise out-of-network bills under this article.
Terms Used In Arizona Laws 20-3117
- Billing company: means any affiliated or unaffiliated company that is hired by a health care provider or health care facility to coordinate the payment of bills with health insurers and to generate or bill and collect payment from enrollees on the health care provider's or health care facility's behalf. See Arizona Laws 20-3111
- department: means the department of insurance and financial institutions. See Arizona Laws 20-101
- Enrollee: means an individual who is eligible to receive benefits through a health plan. See Arizona Laws 20-3111
- Health care provider: means a person who is licensed, registered or certified as a health care professional under title 32 or a laboratory or durable medical equipment provider that furnishes services to a patient in a network facility and that separately bills the patient for the services. See Arizona Laws 20-3111
- Process: means a citation, writ or summons issued in the course of judicial proceedings. See Arizona Laws 1-215
- Surprise out-of-network bill: means a bill for a health care service that was provided in a network facility by a health care provider that is not a contracted provider and that meets one of the requirements listed in section 20-3113. See Arizona Laws 20-3111
B. Health insurers shall include the notice prescribed pursuant to subsection A of this section in each explanation of benefits or other similar claim adjudication notice that is issued to enrollees and that involves covered services provided by a noncontracted health care provider.
C. If an enrollee contacts a health care provider, a provider’s representative or a billing company regarding a dispute involving a surprise out-of-network bill, the health care provider, the provider’s representative or the billing company shall provide written notice as prescribed in subsection A of this section to the enrollee of the dispute resolution process.
D. The department shall post on its website information for health care consumers regarding what constitutes a surprise out-of-network bill, how to try to avoid a surprise out-of-network bill and how the dispute resolution process may be used to resolve a surprise out-of-network bill.