Sinema-Backed Bipartisan Bill Protects Arizonans from Unexpected Medical Bills

Jul 8, 2019

WASHINGTON – Arizona senior Senator Kyrsten Sinema cosponsored the bipartisan STOP Surprise Medical Bills Act—legislation that protects Arizonans from unexpected medical bills.

“Arizona families shouldn’t be forced to pay for surprise medical bills they assumed were covered. I’m working across the aisle to fix flaws in our health care system so it’s more affordable and accessible for all Arizonans,” said Sinema.

Balance or surprise billing happens when a patient goes to an in-network hospital or sees an in-network doctor, but faces unexpected charges because of services received from an ancillary provider—typically a specialist or lab— who is out-of-network. The insurer will pay the ancillary provider’s mandated out-of-network amount, and the remaining balance is often billed to the patient, which can be thousands of dollars. It is also common in emergency situations, when patients need to be taken to the nearest emergency department, regardless of whether it is in their insurance’s network.

The STOP Surprise Medical Bill Act requires patients to pay only their in-network obligations in emergency and other situations where patients cannot reasonably know they are being seen by out-of-network providers. Under the bill, insurers are required to pay out-of-network providers the median in-network rate, and if providers disagree with this payment, they have 30 days to start a dispute resolution process. Part of the legislation’s goals is to avoid costly arbitration by getting insurers to broaden their networks and incentivize providers to set reasonable rates.

Arizona has a similar law that took effect in early 2019, with a similar dispute resolution process.