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: Complete Form SOONBDRR (Surprise Out-of-Network Billing Dispute Resolution Request), and print and sign the form.
STEP 3 (IMPORTANT!): Scan and save to your computer:
- The Form SOONBDRR that you completed and signed in STEP 2
- 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 4: Complete and submit our online "Consumer Complaint" form and attach all the documents that you saved to your computer in STEP 3.
*IMPORTANT: The Consumer Complaint system only allows you one opportunity to attach all the documents that pertain to your request for dispute resolution. It is important that you complete STEP 2 and STEP 3 before going to the online portal so you will be able to upload all your documents as part of your request for arbitration. The Consumer Complaint system 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.