Arizona Balance Billing

Does Arizona Have Balance Billing Law?

Arizona does not have a comprehensive state balance billing law as of 2024. Arizona Revised Statutes §20-1376 provides limited emergency service protections, but the federal No Surprises Act (NSA), effective January 1, 2022, is the primary source of balance billing protections for Arizona patients. The NSA applies to all health plans in Arizona, both state-regulated and ERISA self-funded plans.

Federal No Surprises Act Coverage

The federal NSA protects patients from balance billing in these situations:

• Emergency services: patients pay only in-network cost-sharing regardless of provider network status
• Post-stabilization services: care provided after emergency care at any facility
• Scheduled services at in-network facilities: out-of-network providers cannot balance bill without advance written consent

Qualifying Payment Amounts

The NSA requires insurers to pay out-of-network providers based on a qualifying payment amount (QPA), which is determined using specific benchmarking rules. Patients pay only their in-network cost-sharing amounts in protected situations.

Independent Dispute Resolution

Under the federal NSA, when a provider and insurer dispute an appropriate payment rate for out-of-network services, they can request independent dispute resolution (IDR). This federal process helps resolve payment disputes for NSA-protected services.

Arizona Statutes and Self-Funded Plans

ERISA self-funded plans are governed by federal law under the NSA. State-regulated plans are subject to both state law (limited emergency protections) and NSA protections. Arizona DIFI provides a consumer complaint process for disputes with state-regulated plans.

Frequently Asked Questions

How to Dispute a Balance Bill in Arizona

1. Verify the service qualifies under NSA protection — Confirm that the service was emergency care, post-stabilization care, or scheduled service at an in-network facility provided by an out-of-network provider.
2. Contact your health plan and request NSA adjustment — Notify your insurer of the unexpected out-of-network bill and request they apply No Surprises Act protections, paying the provider at in-network rates.
3. File a federal complaint if the plan denies adjustment — If your plan refuses to apply NSA protections, file a complaint at www.cms.gov/nosurprises with the Centers for Medicare and Medicaid Services.
4. Escalate to DIFI for state-regulated plans — For state-regulated health plans, you may also escalate to the Arizona Department of Insurance and Financial Institutions (DIFI) for additional complaint resolution.