Members have reported an increasing number of concerns regarding healthcare plan practices and what appear to be deliberate attempts by some plans to disrupt, delay or frustrate provider payment. These actions may include, for example, inappropriate payment denials or reductions in payment, delayed payment, unnecessarily difficult appeals processes, administratively burdensome provider audits and recoupment actions. Some of these actions are not necessarily illegal, but some practices, such as failure to comply with prompt-pay statutes, may violate applicable laws.
In response to member requests for assistance on how best to file formal complaints about plans with appropriate oversight agencies, AzHHA has developed a Health Plan Complaint Process Toolkit that includes:
- Provider Health Plan Complaint Process: Overview
- Sample “Long Form” Complaint Letters to Plan Oversight Agencies
- Sample “Short Form” Complaint Letter