Signed by Governor Doug Ducey

Vote Smart's Synopsis:

Vote to pass a bill that establishes an arbitration process for patients to settle surprise medical billing, effective January 1, 2019.

Highlights:

• Specifies out-of-network claim disputes do not apply to the following (Sec. 2):

• Non-covered health care services;

• Limited benefit coverage; or

• Charges for health care services or durable medical equipment subject to a direct payment agreement.

• Authorizes an enrollee who has received and disputes the amount of a surprise out-of-network bill to request arbitration of the bill, provided that the following criteria are met (Sec. 2):

• The amount of the bill is at least $1,000;

• The bill is a surprise out-of-network bill; and

• The enrollee has not signed a disclosure waiving rights to arbitration.

• Requires the enrollee, health care provider, and health insurer to participate in an informal teleconference conference that must be arranged within 30 days of the request for arbitration (Sec. 2).

• Requires the enrollee, prior to arbitration, to agree in writing to pay the health care provider the following (Sec. 2):

• The total amount of the enrollee's cost sharing that is due for the services that are subject of the surprise out-of-network bill, and

• Any amount received from the enrollee's health insurer as payment for the out-of-network services provided

• Requires arbitrations to be conducted within 120 days after the request for arbitration, and the arbitrator must issue a decision within 10 days after the arbitration takes place (Sec. 2).

• Authorizes any party to the arbitration to appeal the arbitrator's decision by filing a demand for trial de novo with the appropriate superior court (Sec. 2).

• Specifies that claims that are subject to arbitration are not subject to statutory requirements relating to timely payment of the health-care provider’s claims and requires a health insurer to remit payment within 30 days of the resolution of the claim (Sec. 2).

• Prohibits the health-care provider from issuing any additional balance bill to the enrollee that was subject to the teleconference or arbitration (Sec. 2).

• Specifies that the effective date of this bill is January 1, 2019 (Sec. 3).

Full Bill Text