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Georgia Senate passes bill to get patients in-network rates if a provider goes out of network
Georgia's state Capitol in Atlanta. - photo by Associated Press

A bill passed by the Georgia Senate Tuesday, Feb. 25 would let patients keep their doctors through the year if those providers go out of network with the patient’s insurance plan.

Under Senate Bill 352, the provider directory a patient sees when they sign up for their benefit plan would stay locked in for the full policy year. The insurer would cover the provider’s charges at in-network rates for the full contract year, even if the provider goes out of network with the insurance plan. 

State Sen. Butch Miller, R-Gainesville, is a co-sponsor of the bill, which will now go to the Georgia House of Representatives. There were no opposing votes in the Senate Tuesday.

“It’s a problem all over the state, not just in Gainesville and Hall County and Northeast Georgia,” Miller said. “... This issue is coming to a community near you soon.”

The bill would have secured access for thousands of Northeast Georgians as the Northeast Georgia Health System and insurer Anthem Blue Cross and Blue Shield negotiated their contract in 2019 and the first week of January. The contract expired Sept. 30, but NGHS honored in-network rates through Dec. 31. 

The two parties signed a new agreement Jan. 6, bringing Anthem back in-network with NGHS. 

Miller and State Rep. Terry England, R-Auburn, stepped in and were scheduled to participate in a public forum about the negotiations in late December. That forum was canceled as Anthem and NGHS neared an agreement, and the two legislators praised the agreement in a statement in January.

“Both NGHS and Anthem worked around-the-clock to keep people informed and reach an agreement that protects the community’s access to high-quality healthcare without leaving this area,” Miller and England said.

Miller said his constituents’ worries about going out-of-network with their providers brought the issue to the forefront for him. 

“We needed some structure and to revisit that issue and make sure that insurance clients are covered for a reasonable and predictable amount of time when they buy a policy,” he said. 

The Georgia Alliance of Community Hospitals spoke in favor of the legislation at an Insurance and Labor Committee hearing Feb. 20.

However, some insurers have concerns. Jesse Weathington with the Georgia Association of Health Plans said at the hearing that the bill would interfere with the contracting process.

“This is something that will impair private contracts between parties. We understand that this is an issue that is becoming increasingly prevalent,” Weathington said. 

It is becoming more common for negotiations to drag out and go past the previous contract’s expiration date, Weathington said. He said the legislation would make it more difficult for insurers to negotiate contracts.

“There would be sort of a big lump to get everything done prior to the beginning of the contract year and have everything align on a 12-month cycle,” Weathington said. “Right now, our provider contracts end where they end, depending on what month they were negotiated at the beginning of the contract term. That would be a disruptive adjustment.”

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