MAG, GCEP & PFC applaud lawmakers for passing surprise billing legislation

The Medical Association of Georgia, the Georgia College of Emergency Physicians, and Physicians for Fair Coverage distributed the following press release on June 18…

Today, a coalition of organizations that represent more than 10,000 physicians in Georgia – including the Georgia College of Emergency Physicians (GCEP), the Medical Association of Georgia (MAG), Physicians for Fair Coverage (PFC), and numerous others – applauded the Georgia Legislature for passing the ‘Surprise Billing Consumer Protection Act’ (H.B. 888), a measure to protect patients and end surprise medical bills in the state. The coalition gave special thanks to the bill’s champions, especially Sen. Chuck Hufstetler (R-Rome) and Rep. Lee Hawkins (R-Gainesville), for demonstrating great vision and leadership throughout the legislative process and for working to pass this legislation with tremendous bipartisan and stakeholder support. The coalition also thanked Gov. Brian Kemp, Lt. Gov. Geoff Duncan, and Chairman Richard H. Smith for their support and leadership. The bill is expected to be signed into law by Gov. Kemp later this week.

“Surprise medical bills have been an ongoing concern for patients across the country and right here in Georgia, until now,” said Brett Cannon, M.D., a PFC board member and an emergency medicine physician in Douglasville. “Nearly two-thirds of the state’s counties are below the statewide average for the number of medical providers per capita, and dozens of rural hospitals face acute funding shortfalls. Now thanks to the leadership of Governor Kemp, Senator Hufstetler, and Representative Hawkins the new law will protect and prioritize what is best for Georgians. This result would not have been possible without the dedication of our partners at the Georgia College of Emergency Physicians and the Medical Association of Georgia. Our mission was to close the insurance gap and eliminate unanticipated, out-of-network medical bills for our patients – and we succeeded.”

“This bill has been at the top of MAG’s list of legislative priorities since 2015, and it represents a significant victory for the state’s health care system,” says MAG President Andrew Reisman, M.D. “MAG thanks and applauds state lawmakers for taking this crucial action, which is going to translate into budget certainty and peace of mind for every Georgian.”  

“The passage of H.B. 888 will have tremendous positive implications for patients across Georgia,” said GCEP President John Sy, D.O. “As physicians, patients have always been our top priority. GCEP would like to thank all the state lawmakers who worked tirelessly to get us to this point. This law will give our patients the certainty they need to seek medical care without fear of receiving a surprise medical bill.”

H.B. 888 will ensure that patients are not left in the middle of insurance disputes between providers and insurers by creating an independent dispute resolution (IDR) process. 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.

Strong Patient Protections

– Patients’ cost-sharing for unanticipated out-of-network (OON) services will be the same as required when they receive in-network services.

– Patients will not have to participate in billing discussions for unanticipated OON services. Instead, negotiations will be between the clinician and the health insurance plan.

– Physicians will be banned from balance billing patients who receive unanticipated OON services.

– Patients are protected from the financial impact resulting from narrow networks, retroactive denials, and cost-shifting trends within health insurance plans. Prior authorization is not required.

– Clinicians will give information to patients and discuss their OON fees before any services are provided, except when it is not possible (e.g., emergency services or unanticipated OON care situations).

– Non-participating providers are prohibited from reporting any patient to a credit reporting agency for failure to pay any amount above that would be required on an in-network basis.

Fair Reimbursement

– Reimbursement for OON care or services will be set at the median in-network amount paid in 2017 for emergency or nonemergency services and annually adjusted for inflation using the Consumer Price Index. 

– Health insurance plans will pay all reimbursements directly to clinicians and will be prohibited from sending the reimbursement to the patient, even if the clinician is OON.

Independent Dispute Resolution

– If it is decided that payment for a claim is not sufficient given the complexity and circumstances of the service or services provided, the provider or facility may request arbitration within 30 days of receipt of payment. Claims may be bundled.

– Once the office of the commissioner of insurance receives a request for arbitration, an additional 30 days will be allowed for negotiation. If there is no agreement, a resolution organization will be notified within five days to begin the arbitration process.

– “Baseball-style” arbitration where each party submits a proposed payment and the arbitrator chooses one.  

– The fees associated with arbitration and any arbitrator expenses shall be paid by the party whose offer was not accepted.

Improved Transparency

– The Georgia Department of Insurance will be required to provide access to verifiable data from a claims database and ensure such information is annually updated and maintained on the department’s website.

– The Georgia Commissioner of the Department of Insurance will submit an annual report to the legislature beginning on July 1, 2022. They will also be required to post a summary on the department’s website that addresses arbitrations filed, settled, arbitrated, defaulted, and dismissed, as well as a description of the decisions made – whether they were in favor of the insurer or the provider.

Effective Date

January 1, 2021

MAG members can contact Derek Norton at dnorton@mag.org with any questions about H.B. 888.