A. Every written contract between a health care services organization and a provider or hospital shall set forth that if the organization fails to pay for covered health care services as set forth in the enrollee's evidence of coverage or contract the enrollee is not liable to the provider or hospital for any amounts owed by the organization and the provider or hospital shall not bill or otherwise attempt to collect from the enrollee the amount owed by the organization.
B. If the written contract between the contracting provider or hospital and the organization fails to contain the required prohibition stated in subsection A, the enrollee is not liable to the contracting provider or hospital for any amounts owed by the organization.
C. No contracting provider or agent, trustee or assignee of the contracting provider or hospital may maintain an action at law against an enrollee to collect any amounts owed by the organization for which the enrollee is not liable to the contracting provider under subsection A.
D. Nothing in this section impairs the right of a provider or hospital to charge, collect from, attempt to collect from or maintain an action at law against an enrollee for any of the following:
1. Copayment or coinsurance amounts.
2. Health care services not covered by the organization, including out of area claims that are not paid by an organization on behalf of an enrollee.
3. Health care services rendered after the termination of the contract between the health care services organization and the provider or hospital, unless the health care services were rendered during confinement in an inpatient facility and the confinement began prior to the date of termination, or unless the provider has assumed post-termination treatment obligations under the contract.
E. Nothing in this section prohibits an enrollee from seeking health care services from a contracting or noncontracting provider or hospital and accepting financial responsibility for these services.
F. No provider or hospital may charge an enrollee of a health care services organization more than the amount the provider or hospital contracted to charge the enrollee pursuant to the provider's contract or hospital's contract with the health care services organization.
G. Nothing in this section prohibits any person from informing an enrollee of either the cost of health care services performed or the status of any bill submitted to an organization in connection with health care services provided to an enrollee. Any information provided to an enrollee pursuant to this subsection shall include a statement that the information is not a bill and is for the enrollee's information only. The statement shall include the following disclosure prominently displayed at the top of the page in all capital letters: "Do not pay this statement. This is not a bill. The information provided below is for information purposes only."
H. Unless preempted under federal law or unless federal law imposes greater requirements than this section, this section applies to a provider sponsored health care services organization.
I. The director shall impose a penalty against any health care provider or hospital in violation of this section of up to three times the amount of the provider or hospital charges at issue.
J. The director shall investigate any complaint filed pursuant to this section and enforce the requirements of this section.
Notes of Decisions
Cited in
8
cases (
1 in the last 5 years), 2000–2021 · leading case:
Samsel v. Allstate Ins., 59 P.3d 281 (Ariz. 2002).
Samsel v. Allstate Ins., 59 P.3d 281 (Ariz. 2002).
· cites it 82× “The court of appeals affirmed, holding that reasonable medical expenses paid on behalf of Lisa Samsel, the injured party, by her health maintenance organization (HMO) were expenses actually incurred by Lisa for purposes of Allstate's medical payments coverage, notwithstanding…”
Haisch v. Allstate Ins., 5 P.3d 940 (Ariz. Ct. App. 2000).
· cites it 34× “See A.R.S. § 20-1072 (1990 and Supp.1998). [1] Haisch was also the insured under an Allstate automobile liability policy that included optional Med Pay coverage *942 of $5,000.”
Andrews v. Samaritan Health Sys., 36 P.3d 57 (Ariz. Ct. App. 2001).
· cites it 19× “May the hospitals assert recapture liens against enrollees of Health Care Services Organizations given the protections of A.R.S. § 20-1072? 3. Is the reservation of a recapture lien in the provider contracts an unenforceable assignment of plaintiffs’ personal injury claims? 4.”
Lopez v. Safeway Stores, Inc., 129 P.3d 487 (Ariz. Ct. App. 2006).
· cites it 4× “See generally A.R.S. §§ 20-1072, 33-931, 33-934; Blankenbaker v.”
Samsel v. Allstate Ins., 19 P.3d 621 (Ariz. Ct. App. 2001).
· cites it 5× “Every written contract between a[n][HMOJ and a provider or hospital shall set forth that if the [HMO] fails to pay for covered health care services as set forth in the enrollee’s evidence of coverage or contract the enrollee is not liable to the provider or hospital for any…”
Swanson v. St. John's Reg'l Med. Ctr., 2002 Cal. Daily Op. Serv. 2821 (Cal. Ct. App. 2002).
“62 [under Arizona statute ( Ariz. Rev. Stat. § 20-1072 ), hospital lien is not a billing or collection action].”
Grunwald v. Scottsdale Healthcare (Ariz. Ct. App. 2021).
· cites it 19× “1 , 8-9 ¶¶ 25–26 (2002) (noting other portions of A.R.S. § 20-1072 “are substantially similar to” NAIC’s HMO Model Act updated as a result of an “NAIC advisory report on HMO regulation and insolvency issues”).”
Lopez v. Safeway Stores, Inc. (Ariz. Ct. App. 2006).
· cites it 2× “Nor can we tell whether she paid, in the way of premiums or otherwise, for the benefit of health insurance coverage under which her providers apparently were bound to accept adjusted, reduced rates in full payment and satisfaction of their services.”
— Ariz. Rev. Stat. § 20-1072(A) — 3 cases
Samsel v. Allstate Ins., 59 P.3d 281 (Ariz. 2002).
“The court of appeals affirmed, holding that reasonable medical expenses paid on behalf of Lisa Samsel, the injured party, by her health maintenance organization (HMO) were expenses actually incurred by Lisa for purposes of Allstate's medical payments coverage, notwithstanding…”
Andrews v. Samaritan Health Sys., 36 P.3d 57 (Ariz. Ct. App. 2001).
“May the hospitals assert recapture liens against enrollees of Health Care Services Organizations given the protections of A.R.S. § 20-1072? 3. Is the reservation of a recapture lien in the provider contracts an unenforceable assignment of plaintiffs’ personal injury claims? 4.”
Grunwald v. Scottsdale Healthcare (Ariz. Ct. App. 2021).
“1 , 8-9 ¶¶ 25–26 (2002) (noting other portions of A.R.S. § 20-1072 “are substantially similar to” NAIC’s HMO Model Act updated as a result of an “NAIC advisory report on HMO regulation and insolvency issues”).”
— Ariz. Rev. Stat. § 20-1072(D) — 1 case
Andrews v. Samaritan Health Sys., 36 P.3d 57 (Ariz. Ct. App. 2001).
“May the hospitals assert recapture liens against enrollees of Health Care Services Organizations given the protections of A.R.S. § 20-1072? 3. Is the reservation of a recapture lien in the provider contracts an unenforceable assignment of plaintiffs’ personal injury claims? 4.”
— Ariz. Rev. Stat. § 20-1072(E) — 2 cases
Samsel v. Allstate Ins., 59 P.3d 281 (Ariz. 2002).
“The court of appeals affirmed, holding that reasonable medical expenses paid on behalf of Lisa Samsel, the injured party, by her health maintenance organization (HMO) were expenses actually incurred by Lisa for purposes of Allstate's medical payments coverage, notwithstanding…”
Samsel v. Allstate Ins., 19 P.3d 621 (Ariz. Ct. App. 2001).
“Every written contract between a[n][HMOJ and a provider or hospital shall set forth that if the [HMO] fails to pay for covered health care services as set forth in the enrollee’s evidence of coverage or contract the enrollee is not liable to the provider or hospital for any…”
— Ariz. Rev. Stat. § 20-1072(F) — 2 cases
Andrews v. Samaritan Health Sys., 36 P.3d 57 (Ariz. Ct. App. 2001).
“May the hospitals assert recapture liens against enrollees of Health Care Services Organizations given the protections of A.R.S. § 20-1072? 3. Is the reservation of a recapture lien in the provider contracts an unenforceable assignment of plaintiffs’ personal injury claims? 4.”
Grunwald v. Scottsdale Healthcare (Ariz. Ct. App. 2021).
“1 , 8-9 ¶¶ 25–26 (2002) (noting other portions of A.R.S. § 20-1072 “are substantially similar to” NAIC’s HMO Model Act updated as a result of an “NAIC advisory report on HMO regulation and insolvency issues”).”
Annotations are extracted automatically from the opinions in the
Syfert caselaw corpus and ranked by authority, recency, and
treatment. Dots show Syfertize treatment of the citing case itself.