Arizona’s Surprise Out of Network Billing Dispute Resolution (SOONBDR) Program
Balance billing – or a surprise medical bill – happens when you get a bill from a doctor, laboratory, durable medical equipment provider, or other health care provider who isn’t part of your health plan’s network. Often, consumers didn’t know they were getting care from out-of-network providers. For example, a patient goes to an in-network hospital for emergency care and is treated by an out-of-network doctor. The doctor and the hospital each bill $1,000 for their services, and the health plan pays them each $400. The in-network hospital can only bill the patient for copays, deductibles, and coinsurance amounts. The out of network doctor, however, may bill for copays, deductibles, and coinsurance as well as any other amounts that the health plan did not pay.
The SOONBDR program is defined in Arizona Revised Statutes 20-3111 through 20-3119, and Arizona Administrative Code R20-6-2401through R20-6-2406
To find out what the requirements of the SOONBRD are, click here.
