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New State, Federal Rules Aim to Eliminate Surprise Medical Bills


Friday, February 19, 2021   

PHOENIX, Ariz. - Navigating the health-care system can be difficult on a good day - dealing with insurance companies, doctors, deductibles and copays is frustrating. But in a recent survey, Arizonans said getting a surprise medical bill after a hospital visit is at the top of their list.

"Surprise" bills are those sent by out-of-network providers, sometimes for thousands of dollars on top of what your insurance pays.

William McGovern, health-care campaign associate with the Arizona Public Interest Research Group Education Fund, said other than the cost, perhaps the biggest problem with these bills is that most people never see them coming.

"Patients do the right thing," said McGovern. "They go in, they check ahead of time if the hospital's in-network, they may even check that the primary doctor they are going to see is in-network. But other doctors that they see while they're there, or maybe the hospital sent their tests to a lab or they have imaging done, and those services end up being out-of-network."

McGovern said regulations are currently in place to help Arizonans deal with surprise bills, and federal legislation will kick in next year, giving patients new rights aimed at leveling the playing field.

He said in the meantime, the state of Arizona has a program that acts as a go-between for patients and out-of-network providers to negotiate the cost of surprise bills.

"The way it works is, if a consumer gets a surprise bill that's over $1,000," said McGovern, "they can file a request to dispute the bill through the Department of Insurance and Financial Institutions, to get that bill reduced."

The "No Surprise Act" is federal legislation that takes effect in 2022, with a robust set of protections that should eliminate most surprise bills. Until then, McGovern said Arizonans can take steps now to protect themselves from out-of-network bills.

"When you make your appointment, you can insist that everyone on your care team is in-network," said McGovern. "And in Arizona, out-of-network providers in network hospitals should give patients a consent form, alerting them to the fact that they're out-of-network."

The Arizona PIRG Education Fund has also developed a detailed "tip sheet" on preventing unexpected medical bills, and how to fight them if they show up. It's online at ''

Disclosure: Arizona PIRG Education Fund contributes to our fund for reporting on Budget Policy & Priorities, Consumer Issues, Energy Policy, Urban Planning/Transportation. If you would like to help support news in the public interest, click here.

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