Arizona law requires that health insurers have a system for resolving payment disputes and other contractual grievances with health care providers. (ARS 20-3102)
The Department of Insurance and Financial Institutions (DIFI) works to ensure that insurers have an effective grievance process in place and that insurers respond to provider grievances within our jurisdiction. DIFI does not have the authority to:
- Determine appropriate payment amounts
- Arbitrate contractual matters, including whether an insurer will contract with a provider
- Address grievances involving the following types of plans;
- Medicare or Medicare Advantage (Part C)
- Federal plans, such as FEBP, Tricare, VA, etc.
- Health Share Ministry
- Plans not issued in Arizona
- Worker’s Compensation(typically)
Use this Provider Grievance Information tool to learn more about when DIFI can help. Resources for plans not regulated by DIFI are listed at the end.
If you feel an insurer has failed to adequately address your grievance, you may file a Provider Grievance with the DIFI. To file a grievance:
- Complete and submit this "Consumer Complaint" form.
- Where the form asks "What is your relationship to the insured?" select "Healthcare Provider."
- Upload supporting documents once the form is completed.
Questions regarding the grievance process may be sent to [email protected].
- Medicare and Medicare Advantage: https://www.cms.gov/
- AHCCCS (Medicaid): https://www.azahcccs.gov/
- Federal employee plans: https://www.opm.gov/
- Tricare: https://www.tricare.mil/
- VA: https://www.va.gov/
- Self-funded employer plans: https://www.dol.gov/agencies/ebsa
- Health Care Sharing Ministries: Contact the plan (Note: these are not insurance contracts; the entity may have no obligation to pay for health care services rendered)
- Insurance plans issued outside of Arizona: Contact the state insurance department in which the plan was issued
- Worker’s Compensation: https://www.azica.gov/