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What surprise medical billing law taking effect means for you
0920 Health stethoscope

The first of two major “surprise billing” laws passed by the Georgia legislature earlier this year takes effect Sunday, Nov. 1. 

The Surprise Bill Transparency Act requires health insurers to provide consumers with the “health benefit plan surprise bill rating” for in-network hospitals, according to a Sept. 29 letter to insurers from the Georgia Office of Insurance and Safety Fire. 

Hospitals that are in-network in insurance plans are rated based on “the number of qualified hospital-based specialty group types,” with X marks indicating “the absence of an in-network qualified hospital-based specialty group.” 

“Health insurers should be prepared to comply fully” on Nov. 1, the state office says. 

Lee Hawkins
Lee Hawkins

“They will put (the ratings) online so the patient knows how their hospital stacks up,” said state Rep. Lee Hawkins, R-Gainesville, on Friday, Oct. 30. “It indicates to the individual that (a particular) hospital has all the things you need in-network. … This is a crack in the door (on surprise billing concerns).” 

The Surprise Billing Consumer Protection Act, which Hawkins, a longtime dentist, sponsored, takes effect Jan. 1. It would help patients avoid “surprise bills,” or unexpectedly high medical costs from receiving care from an out-of-network provider at an in-network facility. 

If a patient goes to an in-network health care facility, they would be charged the in-network fee, even if their provider was out-of-network with their insurer. The insurer and provider would work out the difference, and the bill outlines an arbitration process through the Georgia Insurance Commissioner’s office. 

For nonemergency services, like a regular checkup, patients would be given 48 hours' notice before treatment if they have scheduled with an out-of-network provider. Patients could then decide to change their plans or pay extra. 

The bill takes the patient out of the dispute over cost, Hawkins has said, allowing them to receive treatment without having to worry about going back-and-forth with an insurer or provider. 

Deb Bailey, executive director of governmental affairs for NGHS, has said about surprise billing efforts in the legislature, “We absolutely support patients having as much relevant information as possible when making decisions about their health care, as well as the premise of legislation that would help patients make decisions about elective procedures.” 

And more relief could be on the way for consumers. 

“I continually look at legislation (concerning) the availability and quality of health care for all Georgians, and I will do that in this coming session (starting in January),” Hawkins said.