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GA SB82
Bill
Status
Engrossed
3/1/2021
Primary Sponsor
Michelle Au
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AI Summary
- Clarifies Georgia's "prudent layperson" standard for emergency medical care by explicitly stating that whether a condition qualifies as an emergency is based on the patient's presenting symptoms, not the final diagnosis received after treatment
- Prohibits insurers from denying emergency medical claims solely because the patient's final diagnosis turned out to be non-emergency, if a reasonable person with average medical knowledge would have believed immediate care was necessary based on the symptoms
- Amends definitions of "emergency condition," "emergency services," and "emergency medical services" across six sections of Georgia code, including provisions governing emergency medical services (Title 31), managed care plans, surprise billing, Medicaid care management organizations, the Georgia Right to Shop Act, and preferred provider arrangements (Title 33)
- Responds to legislative findings that Georgia patients have had emergency claims denied due to insurers using final diagnoses to retroactively determine that visits were not emergencies, contrary to the intended application of existing law
- Frames the changes as a clarification of existing legislative intent rather than a new policy, consistent with federal court interpretations of the prudent layperson standard
Legislative Description
Emergency Medical Services; prudent layperson standard is not affected by the final diagnosis given; clarify
Last Action
House Committee Favorably Reported By Substitute
4/1/2022
Committee Referrals
Special Committee On Access to Quality Health Care3/3/2021
Insurance and Labor2/3/2021
Full Bill Text
No bill text available