New Arizona Law Helps Protect Against Excessive Surprise (out-of-network) Medical Billings.

By Michael G. Kelly, Attorney at Law

Kelly Law and Tax

Surprise billings from medical providers who are out of the insurer’s network happen often and are a very unpleasant experience for insured patients.  This often happens when a specialist is summoned unexpectedly by an in-network provider on a medical case and can result in substantial medical bills that are in excess of what insurers will reimburse under the patient’s health plan.

A new law in Arizona seeks to protect patients by providing them with a new dispute resolution system for surprise bills that are at least $1,000 above the combined patient cost-sharing and insurer’s allowable reimbursement. The dispute resolution process includes a pre-arbitration settlement conference and mandatory arbitration to provide a final determination of the matter if it is not settled beforehand.  This will only occur if the patient has exhausted appeals with the insurer. The arbitration must occur in the county where treatment is rendered and may be by phone. The process is designed to take only a few months and there are penalties for noncooperation by either party.

This process, though falling short of limiting the practice of surprise billing like several other states have, is a significant step forward in protecting patients from this very unpleasant surprise.