§ 33-20E-10. Dismissal or Arbitration Requests
The Commissioner shall dismiss certain requests for arbitration if the disputed claim is: Related to a healthcare plan that is not regulated by the state; The basis for an action pending in state or federal court at the time of the request for arbitration; Subject to a binding claims resolution process entered into prior to […]
§ 33-20E-11. Submission to Commissioner by Insurer of Data Pending Arbitration
Within 30 days of the insurer’s receipt of the provider’s or facility’s request for arbitration, the insurer shall submit to the Commissioner all data necessary for the Commissioner to determine whether such insurer’s payment to such provider or facility was in compliance with Code Section 33-20E-4 or 33-20E-5. The Commissioner shall not be required to […]
§ 33-20E-12. Regulation; Contracting With Resolution Organizations
The Commissioner shall promulgate rules implementing an arbitration process requiring the Commissioner to select one or more resolution organizations to arbitrate certain claim disputes between insurers and out-of-network providers or facilities. Prior to proceeding with such arbitration, the Commissioner shall allow the parties 30 days from the date the Commissioner received the request for arbitration […]
§ 33-20E-13. Selection of Arbitrator
Upon the Commissioner’s referral of a dispute to a resolution organization, the parties shall have five days to select an arbitrator by mutual agreement. If the parties have not notified the resolution organization of their mutual selection before the fifth day, the resolution organization shall select an arbitrator from among its members. Any selected arbitrator […]
§ 33-20E-14. Submission of Final Offers; Supporting Documentation
The parties shall have ten days after the selection of the arbitrator to submit in writing to the resolution organization each party’s final offer and each party’s argument in support of such offer. The parties’ initial arguments shall be limited to written form and shall consist of no more than 20 pages per party. The […]
§ 33-20E-1. Short Title
This chapter shall be known and may be cited as the “Surprise Billing Consumer Protection Act.” History. Code 1981, § 33-20E-1 , enacted by Ga. L. 2020, p. 210, § 1/HB 888.
§ 33-20E-2. Application to Insurers; Definitions
This chapter shall apply to all insurers providing a healthcare plan that pays for the provision of healthcare services to covered persons. As used in this chapter, the term: “Balance bill” means the amount that a nonparticipating provider charges for services provided to a covered person. Such amount equals the difference between the amount paid […]
§ 33-20E-3. Exemption
Nothing in this chapter shall be applicable to healthcare plans which are subject to the exclusive jurisdiction of the Employee Retirement Income Security Act of 1974, 29 U.S.C. Sec. 1001, et seq. This chapter shall be applicable only to healthcare plans and state healthcare plans as defined in this chapter. History. Code 1981, § 33-20E-3 […]
§ 33-20E-4. Payment for Emergency Medical Services
An insurer that provides any benefits to covered persons with respect to emergency medical services shall pay for such emergency medical services regardless of whether the healthcare provider or facility furnishing emergency medical services is a participating provider or facility with respect to emergency medical services, in accordance with this chapter: Without need for any […]
§ 33-20E-5. Payment for Nonemergency Medical Services
In accordance with Code Section 33-20E-7 and this chapter, an insurer that provides any benefits to covered persons with respect to nonemergency medical services shall pay for such services in the event that such services resulted in a surprise bill regardless of whether the healthcare provider furnishing nonemergency medical services is a participating provider with […]