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REFERENCE TITLE: health insurers; provider network; denial |
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State of Arizona Senate Fifty-fifth Legislature First Regular Session 2021
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SB 1679 |
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Introduced by Senator Pace: Representative Shah
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AN ACT
amending title 20, chapter 2, article 1, Arizona Revised Statutes, by adding section 20-243; relating to health care insurers.
(TEXT OF BILL BEGINS ON NEXT PAGE)
Be it enacted by the Legislature of the State of Arizona:
Section 1. Title 20, chapter 2, article 1, Arizona Revised Statutes, is amended by adding section 20-243, to read:
20-243. Health care insurers; provider network; denial; written response; definitions
A. If a health care provider requests to join a health care insurer's provider network and the health care insurer denies the request, the health care insurer shall give the health care provider a written response that includes all of the following:
1. An explanation of the basis of the health care insurer's denial.
2. The specific terms and conditions that the health care insurer believes the health care provider does not satisfy.
3. The specific terms and conditions with which the health care provider must comply to be allowed to join the health care insurer's provider network.
4. Detailed instructions that explain the process to follow to file an appeal of the denial.
B. A health care insurer may not deny a request to join the health care insurer's provider network based solely on the health care insurer's perception that additional network health care providers are not needed.
C. For the purposes of this section:
1. "Health care insurer" means a disability insurer, group disability insurer, blanket disability insurer, health care services organization, hospital service corporation, medical service corporation, dental service corporation, optometric service corporation or hospital, medical, dental and optometric service corporation that provides coverage for health care services delivered by a provider network.
2. "health care provider" means an individual or entity that is licensed, registered, permitted or certified as a health care professional or entity under title 32 or 36 and that provides health care services, medical services, nursing services or other health-related services to patients.
3. "Provider network" means a defined set of health care providers under contract with a health care insurer to deliver health care services to persons who are covered under the health care insurer's health care plan.