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The Role of the Director of Insurance

Arizona law (A.R.S. §20-2533(F)) requires “any member who files a complaint with the Department relating to an adverse decision to pursue the review process prescribed” by law. This means that, for appealable decisions, you must pursue the health care appeals process before the Insurance Director can investigate a complaint you may have against our company based on the decision at issue in the appeal.

The appeal process requires the Director to:

  • 1.

    Oversee the appeals process.

  • 2.

    Maintain copies of each utilization review plan submitted by insurers.

  • 3.

    Receive, process, and act on requests from an insurer for External, Independent Review.

  • 4.

    Enforce the decisions of insurers.

  • 5.

    Review decisions of insurers.

  • 6.

    Report to the Legislature.

  • 7.

    Send, when necessary, a record of the proceedings of an appeal to Superior Court or to the Office of Administrative Hearings (OAH).

  • 8.

    Issue a final administrative decision on coverage issues, including the notice of the right to request a hearing at OAH.

Receipt of Documents

Any written notice, acknowledgement, request, decision or other written document required to be mailed is deemed received by the person to whom the document is properly addressed on the fifth business day after being mailed. “Properly addressed” means your last known address.

R-08152b-DENTAL

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