Title 33 — Title 33
0 chapters · 1,218 sections in this title.
O.C.G.A. § 33-20E-1 Short title
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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.
O.C.G.A. § 33-20E-10 Dismissal or arbitration requests
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The Commissioner shall dismiss certain requests for arbitration if the disputed claim is: (1) Related to a healthcare plan that is not regulated by the state; (2) The basis for an action pending in state or federal court at the time of the request for arbitration; 852 33-20E-12 (…
O.C.G.A. § 33-20E-12 Regulation; contracting with resolution organizations
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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 arb…
O.C.G.A. § 33-20E-13 Selection of arbitrator
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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 organ…
O.C.G.A. § 33-20E-14 Submission of final offers; supporting documentation
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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 …
O.C.G.A. § 33-20E-15 Proposed payment amounts
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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 854 33-20E-17 arbitrator may not modify such selected amount. In making such a dec…
O.C.G.A. § 33-20E-16 Payment of expenses and fees
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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 defaulti…
O.C.G.A. § 33-20E-17 Referral of parties for violations
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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 …
O.C.G.A. § 33-20E-18 Limitation on litigation when arbitration sought
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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, § 3…
O.C.G.A. § 33-20E-19 Resolution organizations
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Contracting with, §33-20E-12. Quarterly reporting, §33-20E-19. Rules and regulations, §33-20E-12. Selection of arbitrator, §33-20E-13. Submission of data by insurer to commissioner prior to referral of dispute, §33-20E-11. Balance billing. Denying or restricting benefits based on …
O.C.G.A. § 33-20E-2 Application to insurers; definitions
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(a) This chapter shall apply to all insurers providing a healthcare plan that pays for the provision of healthcare services to covered persons. (b) As used in this chapter, the term: (1) ‘‘Balance bill’’ means the amount that a nonparticipating provider charges for services provi…
O.C.G.A. § 33-20E-20 Annual reporting by Commissioner
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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 summarizin…
O.C.G.A. § 33-20E-21 Insurance companies
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Captive insurance companies. Inapplicability of inconsistent provisions, §33-41-26. Life settlements act. Multiple owners, §33-59-12. Medicaid care management organizations, §33-21A-12. Pharmacy benefits managers. Federal law controlling, §33-64-13. 1120 INDEX CONFUSION. Captive i…
O.C.G.A. § 33-20E-22 Reporting to credit reporting agencies
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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 beyon…
O.C.G.A. § 33-20E-23 Accurate provider directories
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Disclosure of health benefit plan surprise bill rating in advertisement, §33-20C-7. Ambulance services. Financial responsibilities for ground ambulance services, §33-20E-23. Applicability to insurers, §33-20E-2. Exemptions, §33-20E-3. 1180 INDEX HEALTH INSURANCE —Cont’d Surprise b…
O.C.G.A. § 33-20E-3 Exemption
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(a) 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. (b) This chapter shall be applicable only to healthcare plans and state healthc…
O.C.G.A. § 33-20E-4 Payment for emergency medical services
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(a) 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 faci…
O.C.G.A. § 33-20E-5 Payment for nonemergency medical services
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(a) 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 h…
O.C.G.A. § 33-20E-6 Denying or restricting benefits based on balance billing; notice to insured
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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 provide…
O.C.G.A. § 33-20E-7 Surprise bill exclusion; requirements
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(a) Nothing in this chapter shall reduce a covered person’s financial responsibilities in the event that such covered person chose to receive nonemergency medical services from an out-of-network provider. Such services shall not be considered a surprise bill for purposes of this c…
O.C.G.A. § 33-20E-9 Arbitration of payment issues
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(a) If an out-of-network provider concludes that payment received from an insurer pursuant to Code Section 33-20E-4 or 33-20E-5 or if an out-of-network facility concludes that payment received from an insurer pursuant to Code Section 33-20E-4 is not sufficient given the complexit…