§ 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-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-15. Proposed Payment Amounts
Each party shall submit one proposed payment amount to the arbitrator. The arbitrator shall pick one of the two amounts submitted and shall reveal that amount in the arbitrator’s final decision. The arbitrator may not modify such selected amount. In making such a decision, the arbitrator shall consider the complexity and circumstances of each case, […]
§ 33-20E-16. Payment of Expenses and Fees
The party whose final offer amount is not selected by the arbitrator shall pay the amount of the verdict, the arbitrator’s expenses and fees, and any other fees assessed by the resolution organization, directly to such resolution organization. In the event of default, the defaulting party shall also pay such moneys due directly to such […]
§ 33-20E-17. Referral of Parties for Violations
Following the resolution of arbitration, the Commissioner may refer the decision of the arbitrator to the appropriate state agency or the governing entity with governing authority over such provider or facility if the Commissioner concludes that a provider or facility has either displayed a pattern of acting in violation of this chapter or has failed […]
§ 33-20E-18. Limitation on Litigation When Arbitration Sought
Once a request for arbitration has been filed with the Commissioner by a provider or facility under this chapter, neither such provider nor such facility nor the insurer in such dispute shall file a lawsuit in court regarding the same out-of-network claim. History. Code 1981, § 33-20E-18 , enacted by Ga. L. 2020, p. 210, […]
§ 33-20E-19. Quarterly Reporting by Resolution Organizations
Each resolution organization contracted with by the department shall report to the department on a quarterly basis the results of all disputes referred to such organization as follows: the number of arbitrations filed, settled, arbitrated, defaulted, or dismissed during the previous calendar year and whether the arbitrators’ decisions were in favor of the insurer or […]
§ 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-20. Annual Reporting by Commissioner
On or before July 1, 2022, and each July 1 thereafter, the Commissioner shall provide a written report to the House Committee on Insurance and the Senate Insurance and Labor Committee, or their successor committees, and shall post the report on the department’s website summarizing the number of arbitrations filed, settled, arbitrated, defaulted, and dismissed […]
§ 33-20E-21. Exclusion From Other Statutory Provisions
The arbitration conducted under this chapter shall be subject to neither Chapter 13 of Title 50, the “Georgia Administrative Procedure Act,” nor Chapter 11 of Title 9, the “Georgia Civil Practice Act.” History. Code 1981, § 33-20E-21 , enacted by Ga. L. 2020, p. 210, § 1/HB 888.
§ 33-20E-22. Reporting to Credit Reporting Agencies
No nonparticipating provider shall report to any credit reporting agency any covered person who receives a surprise bill for the receipt of healthcare services from such provider and does not pay such provider any copay, coinsurance, deductible, or other cost-sharing amount beyond what such covered person would pay if such nonparticipating provider had been a […]
§ 33-20E-23. Financial Responsibilities for Ground Ambulance Transportation
Nothing in this chapter shall reduce a covered person’s financial responsibilities with regard to ground ambulance transportation. History. Code 1981, § 33-20E-23 , enacted by Ga. L. 2020, p. 210, § 1/HB 888.
§ 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 […]
§ 33-20E-6. Denying or Restricting Benefits Based on Balance Billing; Notice to Insured
No healthcare plan shall deny or restrict the provision of covered benefits from a participating provider to a covered person solely because the covered person obtained treatment from a nonparticipating provider leading to a balance bill. Notice of such protection shall be provided in writing to the covered person by the insurer. History. Code 1981, […]