Law Protecting Patients From 'Surprise Bills' Takes Effect Jan. 1

Published: Monday, December 31, 2018 - 9:38am
Updated: Monday, December 31, 2018 - 10:34am

Arizonans will have a way to dispute unexpected medical bills, or “surprise bills”, starting Jan. 1.

A new law states patients who go to an in-network hospital for service and are later billed for out-of-network care can now dispute the bill through an arbitration process.

“We’ve seen the headlines where someone receives a couple of thousand dollar bills from a health care provider they were not expecting, didn’t anticipate and it’s having some real life consequences for people,” said Stephen Briggs, public information officer for the Arizona Department of Insurance.

The legislation, sponsored by then state senator and now U.S. Rep. Debbie Lesko, does not guarantee that disputes get to an arbitration process. It also says an enrollee is not required to sign a new disclosure notice to obtain medical care, but if an enrollee signs the disclosure notice, the enrollee waives rights to any potential arbitration process once a bill is received.

“Part of what this law requires the department to do is to start tracking some of these and to provide a report here at the end of the year of how frequent, the scope, the average cost,” Briggs said.

The law includes a number of consumer protections, Briggs said, that place the burden on both the health care provider and the insurer to provide cost information up front. The new law also requires out-of-network health care providers to give information to enrollees in a disclosure notice within a reasonable amount of time before treatment.

“So, if somebody is telling them that an x-ray is going to cost $2,500 and it’s out-of-network, they might be able to shop that service around and find an area hospital or facility that provides that service for $700,” Briggs said.

There are two caveats for the arbitration process: the bill amount disputed must be more than $1000 and services must take place after Jan. 1 of 2019.

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