Surprise out-Of-Network Billing Dispute Resolution (Soonbdr) Form - Arizona

Surprise out-Of-Network Billing Dispute Resolution (Soonbdr) Form is a legal document that was released by the Arizona Department of Insurance and Financial Institutions - a government authority operating within Arizona.

FAQ

Q: What is the Surprise Out-of-Network Billing Dispute Resolution (SOONBDR) Form?A: The SOONBDR Form is a dispute resolution process for surprise out-of-network medical bills in Arizona.

Q: How does the SOONBDR Form work?A: The SOONBDR Form allows patients to request assistance in resolving dispute with their health insurer regarding surprise out-of-network bills.

Q: Who can use the SOONBDR Form?A: Any patient who receives a surprise out-of-network medical bill in Arizona can use the SOONBDR Form.

Q: What is a surprise out-of-network medical bill?A: A surprise out-of-network medical bill is a bill for services received from an out-of-network healthcare provider that the patient did not choose.

Q: Is there a deadline to submit the SOONBDR Form?A: Yes, the SOONBDR Form must be submitted within 90 days of receiving the surprise out-of-network bill.

Q: What kind of information do I need to include in the SOONBDR Form?A: You will need to provide information such as the health insurer information, provider information, and a summary of the dispute.

Q: What happens after I submit the SOONBDR Form?A: The Arizona Department of Insurance will review the form and work to resolve the dispute between the patient and health insurer.

Q: Can I still submit the SOONBDR Form if I have already paid the surprise out-of-network bill?A: Yes, you can still submit the form even if you have already paid the bill.

Q: Is there a fee to submit the SOONBDR Form?A: No, there is no fee to submit the SOONBDR Form.