Arbitration for Surprise Healthcare Bills Will Be Available SOON

Phoenix, AZ - A new state law is going into effect that will, under certain circumstances, allow a health plan enrollee who receives health care treatment on or after January 1, 2019, to request arbitration of a so-called “surprise out-of-network, or SOON, bill.”  

 

A SOON billing happens when a health care provider who is not on contract with the health insurance company (also referred to as an “out-of-network provider”) bills a patient for expenses that are not covered by the patient's insurance. The new law applies when patients go to an in-network hospital or facility, perhaps believing the medical services would be covered by their health insurance plans, but later get bills from medical professionals or medical equipment suppliers who do not have contracts under their health insurance plans.  If the bill is $1,000 or more after the enrollee pays cost-sharing amounts (copayment, coinsurance and deductible), and if certain other conditions are met, the enrollee can ask the Arizona Department of Insurance (“AZDOI”) to schedule an arbitration for the bill so that the enrollee only has to pay cost-sharing amounts. 

 

The new law requires out-of-network health care providers to give information to enrollees in a disclosure notice a reasonable amount of time before treatment.  This way, in non-emergency circumstances, an enrollee can decide to delay treatment for a time when a health care provider contracted with the enrollee’s health insurer is available.   The law also says an enrollee is not required to sign the disclosure notice to obtain medical care, but if an enrollee signs the disclosure notice, the enrollee waives rights to the SOON billing arbitration process. 

To see if you are eligible for the SOON billing dispute resolution process, visit the AZDOI’s SOON Billing Dispute Resolution webpage at https://insurance.az.gov/soonbdr

 

The Arizona Department of Insurance, an agency of the State of Arizona, is responsible for the education and protection of insurance consumers and for oversight of the insurance industry in the state.

Health Insurance Telemarketers Annoy; Pose Fraud Risks

Phoenix, AZ—The Arizona Department of Insurance (ADOI) wants to make citizens aware of scams involving aggressive telemarketers attempting to sell health insurance plans and, in some cases, attempting to gain personal and financial information possibly for criminal purposes.

The ADOI has received complaints from people who received multiple phone calls, robocalls, and text messages claiming to be from the National Health Enrollment Center, the Healthcare Enrollment Center and from Healthcare.gov. Some people report that they were contacted multiple times a day, sometimes from different phone numbers, despite requests to be placed on the companies' do-not-call lists. Additionally, some people report having been asked to provide health insurance enrollment information, including such information as address, date of birth, social security number, and personal health information that, in the wrong hands, could be used in identity theft or other fraud schemes.

Arizona citizens who have received persistent phone calls or text messages from these or other callers attempting to sell them health insurance are encouraged to file a complaint with:

Federal Trade Commission (FTC)

Arizona Department of Insurance Consumer Protection Division

  • Visit https://insurance.az.gov/consumers
  • Or call the ADOI’s Consumer Protection Hotline at 602-364-2499, or 1-800-325-2548 if calling within Arizona but outside Maricopa County.

We can all take steps to avoid becoming victims of fraud.

  • Never provide someone who calls you with your bank account number, your social security number, your credit card number, or your personal health information. If you are asked to provide this information, hang up.
  • Research the insurance agent and insurance company you are considering using by finding their license information through the ADOI’s License Search webpage (https://insurance.az.gov/license-search), and use contact information in the license record to contact them. Be skeptical and do research.
  • For information about insurance available from Health Insurance Marketplace, visit the Healthcare.gov website or call Healthcare.gov directly at 1-800-318-2596. The Arizona Department of Insurance is a state agency dedicated to protecting Arizona citizens and businesses by promoting a safe, strong, innovative and competitive insurance marketplace.

The Arizona Department of Insurance is a state agency dedicated to protecting Arizona citizens and businesses by promoting a safe, strong, innovative and competitive insurance marketplace.

Contracting Opportunity for Arbitrators

The Arizona State Procurement Office is procuring Surprise Out-of-Network Dispute Arbitration Services.  Individuals and businesses interested in offering arbitration services must register as a supplier in the Arizona Procurement Portal (https://app.az.gov), and then will be able to locate Souring Project BPM00251.  Bids must be submitted by not later than 3:00 PM MST on Tuesday, December 11, 2018. 

Arizona Sample Notice of Continuation Coverage (Mini-COBRA)

Pursuant to ARS § 20-2330, a health benefits plan issued or renewed after December 31, 2018, must allow an enrollee and any qualified dependent to continue coverage after a qualifying event.  The law requires a small employer (with an average of 1 to 20 employees) to notify an enrollee in writing of the right of the enrollee and any qualified dependents to continue coverage under the employer's health benefits plan upon an enrolee's qualifying event.  Pursuant to Subsection C of the law, the Department has prepared a sample notice of coverage continuation form and is making the sample available on its website.  A small employer that uses, properly completes, and timely issues the Department's form is presumed to satisfy notification requirements.

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