July 17, 2020
Georgia Enacts Favorable Surprise Medical Billing Legislation
On July 16, Georgia Gov. Brian Kemp (R) signed into law House Bill 888, legislation to resolve surprise medical bills. Supported by the Georgia Society of Anesthesiologists (GSA) and a broad medical coalition, this new law removes patients from the middle of billing disputes between health care professionals and insurers by prohibiting health care professionals from balance billing a patient for any amount beyond their in-network, cost-sharing obligations for emergency or non-emergency out-of-network services received without patients’ consent. Insurers will be required to pay the greater of: (1) the in-network amount for same or similar services paid by all eligible insurers (excluding Medicare and Medicaid rates), (2) the most recent in-network amount agreed to between the insurer and the health care professional for the same services, or (3) a higher amount determined by the insurer, given the complexity and circumstances of the services provided.
For disputes regarding the insurer’s payment amount, the measure establishes an arbitration process where the arbitrator must consider the circumstances of the case, the training and education of the health care professional, and evidence submitted by the parties when deciding between the insurer’s payment amount or the health care professional’s billed amount. The new law also creates an all-payer claims database for use in determining the in-network amount for same or similar services. Notably, this new law excludes Medicare and Medicaid rates from payment considerations.
Congratulations to GSA on this favorable solution to surprise medical billing!