SB 1626
Initials AG/AB Page 1 Health & Human Services
ARIZONA HOUSE OF REPRESENTATIVES
Fifty-seventh Legislature
First Regular Session
Senate: HHS DP 7-0-0-0 | 3rd Read 29-0-1-0
SB 1626: health insurance; surprise billing; disputes
Sponsor: Senator Werner, LD 4
Committee on Health & Human Services
Overview
Clarifies that the requirements and procedures related to providing notice to an enrollee of
their statutory right to dispute surprise out-of-network bills applies only to claims that are
not subject to an independent dispute resolution (IDR) under the No Surprises Act (NSA).
History
Laws 2017, Chapter 190, establishes a process for an enrollee who has received a surprise
out-of-network bill to seek a dispute resolution for the disputed amount. A surprise out-of-
network bill is a bill for a health care service, a laboratory service or durable medical
equipment that was provided in a network facility by a health care provider that is not a
contracted provider. A bill must meet certain criteria to qualify as a surprise out-of-network
bill. The dispute resolution process consists of an informal settlement teleconference and
arbitration. The Department of Insurance and Financial Institutions (DIFI) is required to
develop a simple, fair, efficient and cost-effective arbitration procedure for surprise out-of-
network bill disputes, as well as specify time frames, standards and other details for the
arbitration proceeding (A.R.S. §§ 20-3111, 20-3113 and 20-3114).
An enrollee may seek dispute resolution for a surprise out-of-network bill by filing a request
with DIFI within one year of the date of service noted in the surprise out-of-network bill.
DIFI, in conjunction with appropriate health care boards, must prescribe a notice that
outlines an enrollee's rights to dispute surprise out-of-network bills. Health insurers are
required to include the prescribed notice in each explanation of benefits or other similar claim
adjudication notices issued to enrollees that involves covered services provided by a
noncontracted health care provider. 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 must
provide written notice to the enrollee of the dispute resolution process (A.R.S. § 20-3117).
The NSA is a federal law aimed towards protecting consumers from receiving surprise
medical bills resulting from out-of-network care. The federal law also requires health care
insurers to give patients a notice about their surprise billing protections (26 U.S.C. § 9816).
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 apply to individuals covered under short
term limited duration plans, critical illness policies, other limited benefit plans, Medicare,
☐ Prop 105 (45 votes) ☐ Prop 108 (40 votes) ☐ Emergency (40 votes) ☐ Fiscal Note SB 1626
Initials AG/AB Page 2 Health & Human Services
the Arizona Health Care Cost Containment System, Indian Health Services, Veterans Affairs
Health Care or TRICARE (DIFI).
Provisions
1. Clarifies that the requirements for health insurers to provide surprise out-of-network
billing notices to enrollees, only applies to claims that are not subject to an IDR under the
NSA. (Sec. 1)
2. Specifies that 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 that is
not subject to an IDR under the NSA, then the health care provider, a provider's
representative or a billing company must provide the surprise out-of-network billing
notice to the enrollee. (Sec. 1)