Assigned to HHS FOR COMMITTEE
ARIZONA STATE SENATE
Fifty-Seventh Legislature, First Regular Session
FACT SHEET FOR S.B. 1626
health insurance; surprise billing; disputes
Purpose
Applies requirements related to providing notice to a health insurance enrollee regarding
the enrollee's statutory right to dispute surprise out of network medical billing only to dispute
resolution claims that are not subject to an independent dispute resolution (IDR) under the federal
No Surprises Act (NSA).
Background
A bill for a health care service that was provided in a network facility by a health care
provider who is not a contracted provider qualifies as a surprise out of network bill, if the bill was
for: 1) emergency services and health care services directly related to the emergency services that
are provided during an inpatient admission to any network facility; 2) a health care service that
was not provided in the case of emergency and the health care provider or the provider's
representative did not provide the enrollee, within a reasonable amount of time before the enrollee
received the service, a written disclosure containing notice that the health care provider is not a
contracted provider, the estimated total cost to be billed by the provider and that the enrollee is not
required to sign the disclosure to receive medical care but that the enrollee may have waived any
rights to dispute resolution if the enrollee does sign the disclosure; and 3) a health care service that
was not provided in the case of emergency and the enrollee did receive the outlined disclosure but
the enrollee chose not to sign the disclosure (A.R.S. § 20-3113).
An enrollee may seek dispute resolution for a surprise out of network bill by filing a request
with the Department of Insurance and Financial Institutions (DIFI) within one year of the date of
service noted in the surprise out of network bill. DIFI must prescribe a notice that outlines an
enrollee's rights to dispute surprise out of network bills and health insurers must include the
prescribed notice in each explanation of benefits or other similar claim adjudication notice issued
to enrollees that involves covered services provided by a noncontracted health care provider
(A.R.S. §§ 20-3114 and 20-3117).
The NSA requires an insurance company to make a payment to the provider, facility or air
ambulance company within 30 days of receiving the provider's claim. If the provider disagrees
with the amount paid by the insurer, the provider may negotiate a higher payment amount directly
with the insurer. If the provider and insurer cannot come to an agreement, an IDR process is
available for the provider and insurer to settle the payment amongst each other. The NSA applies
to the uninsured, and individuals insured by: 1) individual and group health insurance plans; 2)
student health insurance plans; 3) employer self-funded plans; 4) non-federal government plans,
such as state, county and city plans; 5) church plans; and 6) federal employees health benefit plans.
The NSA does not extend to persons covered under short term limited duration plans, critical
illness policies, other limited benefit plans, Medicare, the Arizona Health Care Cost Containment
System, Indian Health Services, Veterans Affairs Health Care or TRICARE (DIFI). FACT SHEET
S.B. 1626
Page 2
There is no anticipated fiscal impact to the state General Fund associated with this
legislation.
Provisions
1. Specifies that requirements and procedures related to providing notice to an enrollee of the
enrollee's statutory right to dispute surprise out of network medical bills, only applies to claims
that are not subject to an IDR under the NSA.
2. Makes conforming changes.
3. Becomes effective on the general effective date.
Prepared by Senate Research
February 10, 2025
MM/KS/slp