Loading chat...
GA SB8
Bill
Status
Engrossed
2/24/2017
Primary Sponsor
Renee Unterman
Click for details
AI Summary
- Prohibits out-of-network physicians from balance billing covered persons for surprise bills beyond applicable copayments, coinsurance, or deductibles, and requires health care plans to pay nonparticipating physicians using a benchmarking database set at the 80th percentile of charges for the service in the same geographic area
- Establishes an independent dispute resolution process overseen by the Insurance Commissioner for resolving payment disputes over emergency services and surprise bills, with determinations required within 30 days and binding on all parties
- Requires health care providers, hospitals, and insurers to make extensive pre-service disclosures including network participation status, estimated costs for out-of-network services, lists of standard charges, and contact information for contracted physician groups (e.g., anesthesiology, pathology, radiology)
- Exempts emergency service bills from dispute resolution when the billed amount for specified CPT codes does not exceed 120% of usual and customary cost and falls below an annually adjusted threshold starting at $600 in 2018, capped at $1,200
- Creates a nine-member out-of-network reimbursement rate workgroup—comprising physicians, health plan representatives, and consumers—to review current reimbursement methodologies and report recommendations for legislation to the Governor and legislative leaders by January 1, 2018
Legislative Description
"Surprise Billing and Consumer Protection Act"; health insurance; provide consumer protections; definitions
Last Action
House Passed/Adopted By Substitute
3/23/2018
Full Bill Text
No bill text available