NEW ADDRESS Starting January 27, 2020

Arizona Department of Insurance

100 North 15th Avenue, Suite 261

Phoenix, AZ  85007-2630

VISITORS

Citizens, license applicants, process servers:

  • We will continue to provide assistance from Suite 102 through Friday, January 24, 2020. 
  • We will be up and running in Suite 261 starting Monday, January 27, 2020.

 

    MAIL

    Send mail to our new suite number effective immediately (before January 27, 2020). 

    Please make sure to update our address in your contact lists and information systems.

    Surprise Out-of-network Bill Dispute Resolution


    BEFORE SUBMITTING YOUR REQUEST FOR ARBITRATION USING THE ONLINE PORTAL:

    STEP 1: Review information on this web page (https://insurance.az.gov/soonbdr) and confer with your health insurer to determine whether your healthcare bill qualifies as a surprise bill that is eligible for the dispute resolution process.  

    STEP 2 (IMPORTANT!):  Scan and save to your computer:

    • Your insurance card, front and back
    • Correspondence (letters, memos, bills, etc.) between you, the provider, and the insurer relating to this bill
    • Other information that will help explain this matter

    STEP 3:  Use the online portal link below (link is external) to submit your request to the Department:  

    *IMPORTANT: The portal only allows one opportunity to attach documents. It is important that you complete STEP 2 before going to the online portal so you will be able to upload all your documents as part of your request for arbitration.  The portal will transfer your documents to us in a secure, encrypted manner.  

    If you were unable to attach all related documents, do NOT submit a new request.  You may contact us at [email protected] and we will provide an alternate method to obtain the documents.  Please make sure to reference your dispute number. 

    ONLINE PORTALhttps://azinsurance.online/soonbdrs


     

    Form SOONBDRFI-I: Request for Information - Insurer

    Surprise Out-of-Network Billing Dispute Request for Information (SOONBDRFI) form that a health insurer will need to be complete and return with attachments in response to a Department of Insurance request for information concerning a surprise out-of-network billing dispute resolution (SOONBDR) request.

    Form SOONBDRFI-P: Request for Information - Healthcare Provider

    Surprise Out-of-Network Billing Dispute Request for Information (SOONBDRFI) form that a healthcare provider will need to be complete and return with attachments in response to a Department of Insurance request for information concerning a surprise out-of-network billing dispute resolution (SOONBDR) request.

    Form SOONBDRIST-S: Informal Settlement Conference Scheduling Details

    This form is completed and uploaded into the Surprise Out-of-Network Dispute Resolution System (SOONBDRS) by a health insurer to report the details as to the date, time and participation instructions for an informal settlement teleconference ("IST").

    Form SOONBDRIST: Informal Settlement Teleconference Outcome

    The health insurer involved in a surprise out-of-network dispute will complete this form after a scheduled informal settlement teleconference ("IST") is held.  The insurer is responsible for reporting the outcome of the IST.

    SOONBDRA: Arbitration Decision

    The arbitrator that conducts the arbitration proceeding for a surprise-out-of-network dispute will complete this form to notify the Department of the outcome of the arbitration.