Arizona Laws 20-3113. Surprise out-of-network bill; requirements; notice
A. 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 must meet one of the following requirements to qualify as a surprise out-of-network bill:
Terms Used In Arizona Laws 20-3113
- Contracted provider: means a health care provider that has entered into a contract with a health insurer to provide health care services to the health insurer's enrollees at agreed on rates. See Arizona Laws 20-3111
- 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
- Health care services: means treatment, services, medications, tests, equipment, devices, durable medical equipment, laboratory services or supplies rendered or provided to an enrollee for the purpose of diagnosing, preventing, alleviating, curing or healing human disease, illness or injury. See Arizona Laws 20-3111
- Health insurer: means a disability insurer, group disability insurer, blanket disability insurer, hospital service corporation or medical service corporation that provides health insurance in this state. See Arizona Laws 20-3111
- Health plan: means a group or individual health plan that finances or furnishes health care services and that is issued by a health insurer. See Arizona Laws 20-3111
- including: means not limited to and is not a term of exclusion. See Arizona Laws 1-215
- Network facility: means a health care facility that has entered into a contract with a health insurer to provide health care services to the health insurer's enrollees at agreed on rates. See Arizona Laws 20-3111
- 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
1. The bill was for emergency services, including under circumstances described by section 20-2803, subsection A and health care services directly related to the emergency services that are provided during an inpatient admission to any network facility.
2. The bill was for a health care service that was not provided in the case of an emergency and the health care provider or the provider’s representative did not provide to the enrollee, or did not provide to the enrollee within a reasonable amount of time before the enrollee received the services, a written dated disclosure that contained the following information:
(a) Notice that contains the name of the billing health care provider and that states the health care provider is not a contracted provider.
(b) The estimated total cost to be billed by the health care provider or the provider’s representative.
(c) Notice that the enrollee or the enrollee’s authorized representative is not required to sign the disclosure to obtain medical care but if the enrollee or the enrollee’s representative signs the disclosure, the enrollee may have waived any rights to dispute resolution under this article.
3. The bill was for a health care service that was not provided in the case of an emergency and the enrollee received the disclosure prescribed in paragraph 2 of this subsection, but the enrollee or the enrollee’s authorized representative chose not to sign the disclosure.
B. Notwithstanding any provision of this article, a health insurer and any health plan offered by a health insurer shall comply with chapter 17, article 1 of this title.