Bill > SB1397

This bill establishes a comprehensive Health Care Claims Consumer Assistance Program within the Arizona Department of Insurance to support health plan consumers. The program will provide multiple services, including helping consumers file insurance complaints and appeals, settling claim disputes, educating consumers about their insurance rights, assisting with obtaining health insurance coverage, and helping consumers access federal health insurance tax credits. Health insurers will be required to prominently display information about this program on their communications. The bill introduces significant enforcement mechanisms, allowing the department to impose civil penalties up to $25,000 for insurers who wrongfully deny or insufficiently cover valid claims. The program will also collect and track consumer insurance inquiries and problems, and will be required to produce an annual public report detailing claim denial statistics, appeal information, and investigation outcomes. Health insurers must disclose claim denial data to the department and can face license suspension or revocation for repeated violations. The bill provides detailed criteria for assessing penalties, including factors like the nature of violations, insurer's historical conduct, and potential harm to consumers. Notably, if a court finds an insurer has wrongfully denied a claim, the insurer becomes automatically liable to pay double the denied amount plus attorney fees. The program aims to increase transparency, protect consumer rights, and create accountability in health insurance claims processing.

Budget and Finance

https://apps.azleg.gov/BillStatus/BillOverview/82802