GEORGIA LEGISLATURE PASSES "SURPRISE BILLING" BILL SUPPORTED BY THE MEDICAL ASSOCIATION OF GEORGIA, THE GEORGIA HOSPITAL ASSOCIATION AND OTHER PROVIDER GROUPS

The Georgia legislature has passed H.B. 888, the “Surprise Billing Consumer Protection Act,” which was supported by the Medical Association of Georgia (MAG), the Georgia Hospital Association, the Georgia College of Emergency Physicians, and other provider groups. The bill is expected to be signed by Georgia Governor Brian Kemp.

Patients can receive unanticipated out-of-network services when they are treated by an out-of-network physician in an in-network hospital or other medical facility. An underlying cause of the problem is health insurers’ adoption of narrow networks, with a limited number of in-network providers, and/or their offering of below-market rates to in-network physicians.

The bill protects patients by limiting their cost-sharing responsibility for unanticipated out-of-network services to their in-network cost-sharing amounts and by prohibiting providers from banning balance billing these patients.

The bill provides for fair reimbursement to out-of-network physicians by requiring health insurers to pay them the median in-network 2017 rate, annually adjusted for inflation. There’s also an independent dispute resolution provision for physicians to use when they believe that the payment received from an insurer is not sufficient given the complexity or the circumstances of the services provided. This process allows for a period of negotiation. If negotiations don’t succeed, the parties can use “baseball-style” arbitration, pursuant to which the physician and the health insurer each submit a suggested payment amount to an arbitrator, who picks one of these amounts.

The bill also protects physicians by requiring health insurers to pay physicians directly as opposed to sending payments to patients.

In a statement, MAG said that “H.B. 888 will ensure that patients are not left in the middle of insurance disputes between providers and insurers…Not only does this bill limit out-of-pocket expenses to in-network cost-sharing requirements, but it is also a fair and balanced approach that preserves access to care.”

The law is scheduled to take effect January 1, 2021.

Georgia H.B. 888, the Surprise Billing Consumer Protection Act, is linked here.