GA SB359

Carriers must pay nonparticipating providers directly for emergency medical care at the lesser of actual billed charges or the minimum benefit standard (80th percentile of charges in the same specialty and geographic area), with first dollar coverage and no prior authorization required, within 15 days for electronic claims and 30 days for paper claims.

Covered persons receiving emergency care from out-of-network providers are limited to in-network cost-sharing amounts (copays, coinsurance, deductibles), and out-of-network deductible amounts must be applied to the in-network deductible; neither participating nor nonparticipating providers may balance bill patients for emergency care.

Physicians and hospitals must disclose to patients in advance of nonemergency services the names, contact information, and network participation status of providers expected to deliver care, including anesthesiology, pathology, and radiology groups; hospitals must also post standard charges and accepted health plans on their websites.

Mediation through the Department of Insurance is available for surprise bills exceeding $1,000 arising from unanticipated out-of-network charges during elective medical care, with costs shared evenly among the patient, insurer, and provider.

Carrier violations are classified as unfair trade practices subject to department penalties; carriers must arrange and pay for patient transfers to in-network providers once stabilized, and if transfer does not occur within 24 hours, the carrier must pay the nonparticipating provider's full charges going forward.