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HB 888 (”Surprise Billing Consumer Protection Act”) was signed into law by Governor Brian Kemp on July 16, 2020, and became effective on the same date. Section 1 of HB 888 amended Title 33 by adding a new chapter to provide for certain consumer protections against surprise billing and exempt healthcare plans that are subject to the exclusive jurisdiction of the Employee Retirement Income Security Act of 1974. (”ERISA”)
Request for arbitration
Requests for arbitration under OCGA § 33-20E-9 should be submitted through the department GovLink portal. Instructions on submitting requests via the portal can be found HERE. The requests submitted via the portal will also be sent concurrently to the health insurer.
Providers and Facilities
Those submitting requests should review whether their claims are eligible for surprise billing arbitration. Such provider or facility shall submit such request within 60 days of receipt of such payment for the claim and concurrently provide the insurer with a copy of such request.
Providers and facilities should note that the application allows only claims related to four enrollees per Arbitration request. A request for arbitration may involve a single patient and a single type of healthcare service, a single patient and multiple types of healthcare services, multiple patients and a single type of healthcare service, or multiple substantially similar healthcare services in the same specialty on multiple patients, as required by OCGA § 33-20E-9(b).
Arbitration requests containing more than four enrollees or spreadsheets with large numbers of claims or enrollees with dissimilar healthcare services will be rejected.
Providers and Facilities and the Healthcare Plan have 60 calendar days to negotiate a settlement on the claim before the claim is sent to arbitration.
Health Insurers
Insurers must submit all data necessary for the Commissioner to determine whether such insurer’s payment to such provider or facility was in compliance with the Surprise Billing Consumer Protection Act or any objections that the claim is ineligible for Arbitration under the Surprise Billing Consumer Protection Act. If an insurer fails to submit such data, the Commissioner may assess penalties against such insurer or declare a default judgment against such insurer.
Self-Funded Health Plans Election to Participate in Surprise Billing Consumer Protection Act
HB 234 was signed into law by Governor Brian Kemp on April 29, 2021, and became effective on the same date. Section 3 of HB 234 amended O.C.G.A. § 33-20F et. seq. to allow self-funded healthcare plans operating in Georgia to elect to participate in the Surprise Billing Consumer Protection Act.
Health Plans subject to the exclusive jurisdiction of the Employee Retirement Income Security Act of 1974 that elect to participate in the Surprise Billing Consumer Protection Act shall provide notice to the Commissioner of its election decision on a form prescribed by the Commissioner as required by O.C.G.A. § 33-20F-2 (b).
Self-funded healthcare plans who wish to opt into the Surprise Billing Consumer Protection Act will complete the online form indicating their desire to participate in the Surprise Billing Consumer Protection Act.
A list of self-funded healthcare plans that have chosen to participate in and comply with the Surprise Billing Consumer Protection Act.