2017 Arizona Revised Statutes
Title 20 - Insurance
§ 20-3114 Dispute resolution; settlement teleconference; arbitration; surprise out-of-network bills
20-3114. Dispute resolution; settlement teleconference; arbitration; surprise out-of-network bills
(Eff. 1/1/19)
A. An enrollee who has received a surprise out-of-network bill and who disputes the amount of the bill may seek dispute resolution of the bill if all of the following apply:
1. The enrollee has resolved any health care appeal pursuant to chapter 15, article 2 of this title that the enrollee may have had against the health insurer following the health insurer's initial adjudication of the claim.
2. The amount of the surprise out-of-network bill for which the enrollee is responsible for all related health care services provided by the health care provider whether contained in one or multiple bills, after deduction of the enrollee's cost sharing requirements and the insurer's allowable reimbursement, is at least one thousand dollars.
3. The enrollee received a surprise out-of-network bill.
B. If an enrollee requests dispute resolution of a surprise out-of-network bill, the enrollee shall participate in an informal settlement teleconference and may participate in the arbitration of the bill. The health care provider or the provider's representative and the health insurer shall participate in the informal settlement teleconference and the arbitration.
C. An enrollee may not seek dispute resolution of a bill if the enrollee or the enrollee's authorized representative signed the disclosure prescribed in section 20-3113, paragraph 2 and the amount actually billed to the enrollee is less than or equal to the estimated total cost provided in the disclosure.
