Arizona Laws 20-3118. Surprise out-of-network bills; annual report
A. On or before December 31, 2019 and each December 31 thereafter, the department shall report on the resolution of disputed surprise out-of-network bills. The report shall include:
Terms Used In Arizona Laws 20-3118
- Arbitration: means a dispute resolution process in which an impartial arbitrator determines the dollar amount a health care provider is entitled to receive for payment of a surprise out-of-network bill. 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
- 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
- Process: means a citation, writ or summons issued in the course of judicial proceedings. See Arizona Laws 1-215
- Settlement: Parties to a lawsuit resolve their difference without having a trial. Settlements often involve the payment of compensation by one party in satisfaction of the other party's claims.
1. The total number of inquiries regarding dispute resolution of surprise out-of-network bills.
2. The total number of requests that did not qualify for dispute resolution and the reasons why the disputed bills did not qualify.
3. The number of requests that qualified for dispute resolution.
4. The most common requests for dispute resolution by health care provider specialty area.
5. The most common requests for dispute resolution by health care service.
6. The number of requests for dispute resolution by geographic area in this state.
7. The most common requests for dispute resolution based on the type of health care facility in which the health care services were provided.
8. The number of requests for dispute resolution that were settled during a settlement teleconference.
9. The number of requests for dispute resolution that were settled during arbitration.
10. The number of times a health insurer, a health care provider or the provider’s representative or an enrollee failed to attend the settlement teleconference.
11. The average percentage by which disputed surprise out-of-network bills were reduced from the initially billed amount.
12. Any additional information that the department determines is relevant in evaluating the effectiveness of the dispute resolution process.
B. The department shall submit the report to the governor, the president of the senate and the speaker of the house of representatives and shall provide a copy of the report to the secretary of state.