SB1024 Summary

• Expands dispute resolution process to cover balance bills from health care services organizations and health care providers, in addition to existing surprise out-of-network bills from health insurers.

• Allows health care services organizations or health care providers to initiate arbitration for balance bills of $1,000 or more, requiring informal settlement teleconference before arbitration proceedings.

• Permits self-funded or self-insured employee benefit plans (normally preempted by federal ERISA law) to voluntarily comply with Arizona's dispute resolution requirements by entering written agreement with the Department of Insurance, with department-determined fees covering administration costs.

• Establishes that health care services organization enrollees cannot be balance billed amounts exceeding their in-network cost-sharing requirements and must be held harmless by both the organization and provider for disputed amounts.

• Adds "balance bill" to definitions and modifies article heading from "out-of-network claim dispute resolution" to "out-of-network surprise bills and balance bills dispute resolution."