Press Release 2000-24 New Law Establishing Timely Pay Requirements and Grievance Provisions for Health Care Providers Takes Effect Jan. 1

NEW AGENCY


Arizona Department of Insurance
100 North 15th Avenue, Suite 261

Phoenix, AZ  85007-2630


Starting July 1, 2020, we became the
Department of Insurance and Financial Institutions (DIFI).


Media Contact: Don Harris, Public Information Officer, (602) 912-8402

For Immediate Release December 28, 2000

Arizona Insurance Director Charles R. Cohen said the Insurance Department is prepared to begin administering a new law that provides time limits and procedures for health insurers to pay providers and resolve provider grievances.

The timely pay and grievance law is part of House Bill 2600, or the Managed Care Accountability Act, which the Arizona Legislature enacted in 2000. The timely pay and grievance provisions of the Act apply to all health insurers, not just managed care plans. The law, which goes into effect January 1, 2001, does not apply to AHCCCS, Medicare fee-for-service, county health system, workers compensation or self-insured employer claims.

According to Cohen, this new legislation is an important, positive step toward addressing concerns of providers regarding their right to be paid in a timely manner and to have their disputes with insurers resolved fairly and expeditiously.

“The Arizona Legislature, and particularly the primary sponsor of HB 2600, Rep. Barbara Leff, are to be commended for enacting this important new law,” Cohen said. “It not only gives health care providers important new rights, it gives the Insurance Department critical tools for monitoring network adequacy and financial solvency of health insurers.”

Under the new law, health insurers generally must approve or deny a “clean” or complete claim from a provider within 30 days, and must pay interest on late payments at a 10 percent annual rate, unless a different rate is specified in the contract between the provider and insurer. The insurer’s obligation to pay interest may not be waived.

The law limits the kind of supporting information insurers can request from providers, and prevents insurers or providers from seeking adjustments of payments more than one year after the payment was made.

The grievance provisions of the law require all health insurers to establish an internal grievance system for resolving disputes with contracted and non-contracted providers. The Insurance Department is requiring all health insurers to make their grievance policies available to providers and to provide the Department with the name of a grievance contact person.

The law also requires insurers to file semi-annual reports with the Department summarizing their grievance records. The reports will be public records under state law. The Department will use the reports, along with other information, to assess whether particular insurers are generally complying with the timely pay and grievance laws, and to analyze whether they appear to have problems in related areas, like financial solvency and network adequacy, which require targeted regulatory attention.

The Department has also established form and content requirements for an insurer’s semi- annual grievance reports. These requirements include the number and types of grievances filed, the types of resolution, the average number of days to resolution and the average amount in dispute per payment grievance.

The Insurance Department has established a Provider Information Line at (602) 912-8468 to provide information to providers about the timely pay and grievance laws. The Department also has information available on its Internet web site at www.state.az.us/id including a comprehensive bulletin (“Circular Letter 2000-15”) recently issued by Director Cohen to health insurers regarding their compliance requirements, and a timely pay and grievances pamphlet that summarizes the new law and how it will be administered.

While the law greatly strengthens providers’ rights to timely payment, it does not give the Insurance Department the authority or resources to adjudicate individual claims or resolve disputes between insurers and providers. Providers who have payment or contract disputes with insurers should submit written grievances directly to the insurer. Grievances should not be submitted to the Insurance Department. If providers contact the Department for help with particular claims or grievances, the Department will refer them to each insurer’s designated grievance contact person.

“It is important for providers to understand that while the new law requires insurers to have procedures and systems in place to address their timely payment complaints and other contractual disputes, it does not make the Insurance Department into a court to resolve those disputes or a collection agency to pursue payment,” Cohen said. “The Department will fulfill its responsibility to assure that insurers put these systems into place, but it is still up to providers to pursue payment and grievances on their own behalf.”

Director Cohen plans to integrate this new scheme for timely payment of providers with the regulatory framework the Department is developing under another piece of 2000 legislation. Senate Bill 1330 transferred regulatory oversight for HMO quality assurance and network adequacy from the Department of Health Services to the Insurance Department, effective July 1, 2001. Cohen said issues pertaining to timely payment of providers are highly related to an insurer’s network stability and financial solvency, and will mesh naturally in the new oversight program.

-30-

Period: 
2000
Priority: 
24
Insurers Offering Individual Health Insurance in Arizona

Lists insurance companies that are offering health insurance to individuals and families in Arizona in 2020.  Open enrollment starts November 1st and now runs through December 17th, 2019.  Individuals can start shopping for coverage now at healthcare.gov or cuidadodesalud.gov (Spanish)

Notice of Proposed Rulemaking - Corporate Governance Annual Disclosure Model Regulation In 2019, the Arizona Legislature adopted the NAIC Corporate Governance Annual Disclosure Model Act at Arizona Revised Statutes (“ARS”) by enacting the Corporate Governance Act at Title 20, Chapter 2, Article 16 (Laws 2019, 1st Reg. Sess., Ch. 180, § 1).   The Department of Insurance (“Department”) seeks to adopt the correlate Corporate Governance Annual Disclosure Model Regulation.  ARS § 20-492.02 allows the Department to adopt rules to carry out the Act upon notice and an opportunity to be heard.  The Legislature has exempted the Department from Title 41, Chapter 6 for one year after the effective date of the Act.  (Laws 2019, 1st Reg. Sess., Ch. 180, § 2.)
Arizona's Surprise Bill Resolution Report for 2019

As shown in the attached report prepared pursuant to A.R.S. § 20-3118(A), the Department of Insurance received 91 requests for dispute resolution in Calendar Year 2019.  Of those, 53 have been resolved or closed, and health plan enrollees saved $41,538 by submitting their surprise bills for resolution.  

Not all health care bills qualify for the surprise bill resolution process.  The Department's Suprise Out-of-network Billing Dispute Resolution website (https://insurance.az.gov/soonbdr, and especially the section entitled, "I got a surprise bill. Can I submit a request for arbitration?") lists conditions when a health care bill may not qualify under Arizona law for the dispute resolution process.  But for those that do, the enrollee will only be responsible for paying the enrollee's cost-sharing amounts (copay, coinsurance and deductible) if the enrollee provides information the Department needs, and participates in an informal settlement teleconference with the health care insurer and the health care provider.

Fire Readiness and Your Insurance Coverage

Complete three steps to be prepared

STEP ONE: Inventory your contents. 
Making a record of what you have provides two major benefits.  First, it could help you estimate the cost of replacing your contents, which you could use to make sure you have enough insurance coverage.  Second, it will help you identify missing or destroyed items if you need to file an insurance claim. Keep your inventory records in a safe place outside your home, such as a safe deposit box at a bank, or in a secure online location. 

  • The National Association of Insurance Commissioners (NAIC) has a free app called, “MyHome Scr.APP.book,” available from Google Play and from the Apple App Store, which can help you keep track of your personal property. 
  • The Insurance Information Institute provides advice that can make creating a home inventory easier (https://www.iii.org/article/how-create-home-inventory).

STEP TWO: Understand what your homeowners’ insurance policy covers.
If you do not have your policy on hand, get a copy from your insurance company or insurance agent. Then, make sure your policy provides enough coverage for your dwelling, contents and additional living expenses.

  • Dwelling Coverage:  This pays to reconstruct your home, from ground up if necessary.  It does not include the cost of the land on which your home sits because you will still have that, but it should include the cost to remove a destroyed structure and replace it a home that is similar to what you had prior to the fire.
  • Contents Coverage:  This pays to repair or replace your personal belongings. Your policy may provide contents coverage based on a set percentage of your dwelling coverage, but you can pay for more contents coverage if you think you need it. 
    • Check to see if your coverage will pay “actual cash value” or “replacement cost.”  Actual cash value (ACV) means what an item was worth when it was destroyed based on its initial cost minus depreciation or loss in value due to its age, condition and wear-and-tear.  Replacement cost (RC) means the cost to replace or repair damaged or destroyed property with materials of “like kind and quality”. Claims for damaged or destroyed items will initially be paid based on the ACV of the item.  When the item is replaced, a copy of the receipt must be provided to the insurance company to obtain payment of the balance owed.  Many policies require the damaged items to be replaced within six (6) months.
    • If you have expensive items, such as artwork, jewelry or computers, you can purchase or increase “scheduled” property coverage to make sure you have sufficient coverage for those items.
  • Additional Living Expense (a.k.a. Loss of Use) Coverage. This pays additional costs you may resulting from the property damage.  For example, if you are not able to live in your home, your policy may cover the costs of lodging and food, boarding your pets, etc.

Importantly, insurance policies are often lengthy, detailed documents.  Do not hesitate to contact your agent or insurance company representative if you have any questions. 

STEP THREE: Minimize your fire risk.
Periodically inspect your home for overloaded power strips, damaged electrical cords or other potential fire hazards.  Keep vegetation and combustible materials away from your home.  If you are in an area that is at higher risk for wildfire, follow “Avoiding Wildfire Damage” guidelines published by the Federal Emergency Management Agency (https://www.fema.gov/pdf/hazard/wildfire/wdfrdam.pdf). 

Remain organized and keep good records

If you are the victim of a fire, remaining organized after an event can be difficult, but it is essential so that you can receive the benefits that your insurance coverage provides.

  • Keep all receipts for living expenses (housing, food, etc.) and for all items that you replace or repair.  Insurance companies may require that you submit original receipts. You should either copy, scan or take clear photos of receipts to provide yourself a backup. 
  • Take photos of your property and the damage.
  • Keep records of all your conversations, emails and letters about your claim with your insurance company and agent.  Take notes of conversations, documenting who you talked to, when you talked to them and what you were told. When possible, send an e-mail message to the person with whom you had the conversation to confirm your understanding of what you were told.
  • Do not throw away or destroy damaged property until your insurer inspects the property and tells you in writing/e-mail that you can do so.
  • Take an inventory of the damaged contents.  If you have an inventory from before the fire, use it to help identify items that were damaged/destroyed. 
  • When the insurer inspects the damage, do a complete walkthrough of your property and point out any issues or concerns you have.
  • When beginning the repair process, get multiple repair estimates from licensed contractors (look up records on the Arizona Registrar of Contractors “Contractor Search” page at https://roc.az.gov/contractor-search) with good reputations (look up records on the Better Business Bureau website at https://www.bbb.org).
  • Don’t delay.  Insurance policies generally have restrictions on how long after a fire you can file claims.

Persons with disabilities may request materials in an alternative format by contacting our Americans with Disabilities Act Coordinator at (602) 364-0108. 

Regulatory Bulletin 2020-02

Implementation of Executive Order 2020‐07 Proactive Measures to Protect Against COVID‐19 and Executive Order 2020‐15 Expansion of Telemedicine.

Regulatory Bulletin 2020-03

Complying with Regulatory Requirements during the Public Health Emergency

Regulatory Bulletin 2020-04

COVID-19 and Insurance Customer Relief; Flexibility

Regulatory Bulletin 2020-01

Uninsured and Underinsured Motorist Coverage Offer Form; SB1087