Arizona lawmakers target ‘surprise billing’

Arizona lawmakers are working on a set of proposals designed to give more protection to patients who receive unanticipated medical bills from out-of-network providers, as legislators across the nation continue to fight the issue known as “surprise billing.”


Arizona’s main effort to combat the unexpected fees is much weaker than proposals made in other states.

Though most patients do their due diligence to make sure care from doctors and medical facilities are part of their insurance networks, healthcare consumers all over the country are repeatedly being hit with surprise medical bills. Patients typically incur the unexpected fees because of hospitals’ contracted use of out-of-network providers who work as specialists.

Sponsor Sen. Debbie Lesko, R-Peoria, said Senate Bill 1441 would help solve a state issue that patients have no control over.

“They have no choice over which doctor is going to treat them and they get a bill for possibly thousands of dollars,” Lesko said during the Senate’s final vote on the floor.

The legislation would require patients, insurers and providers to first try to settle the dispute in an informal phone call before advancing to arbitration if an agreement cannot be reached. Consumers could ask the Arizona Department of Insurance to assign an arbitrator to settle the dispute if they receive a bill of $1,000 or more from out-of-network providers. Both providers and insurers would split the costs of the arbitration.

Other states have taken harder stances on the issue. Some lawmakers have proposed measures that curb surprise billing by banning it.

Legislation signed into law in California mandates patients who receive non-emergency care in in-network facilities only must pay in-network cost sharing. Health plans must pay non-contracting physicians either the plan’s average contracted rate or 125 percent of the Medicare rate depending on which is greater.

Under a Montana proposal, if patients ask in writing, insurers or facilities are required to disclose whether the service or care of other health care providers is needed, and give an estimate of those charges if it costs more than $500.

Lesko said the bill is modeled after legislation in Texas, and noted 94 percent of surprise billing cases are settled over the phone there.

The legislation passed the Senate on a 25-5 vote earlier this month and awaits House action.

Christina Cousart, a policy associate at the National Academy for State Health Policy, said aside from specialist care, the unexpected bills often arise from emergency transportation such as helicopter lifts.

Senate Bill 1321 by Sen. Sean Bowie, D-Phoenix, would require the Insurance Department director to produce a report on surprise billing in the state by January of next year.

Stephen Briggs, an agency spokesman, said the department does not track complaints about surprise billing in the state.

Opponents say the measure would likely not solve the problem and would only add more complexity to the already over-regulated health care industry in place.

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