Regardless of whether the healthcare provider or facility furnishing emergency medical services is a participating provider or facility with respect to emergency medical services. 134 (b) In the event a covered person receives the provision of emergency medical services from a nonparticipating emergency medical provider, the nonparticipating provider shall collect or bill no more than such person's deductible, coinsurance, co-payment, or other cost-sharing amount as determined by such person's policy directly and such insurer shall directly pay such provider the greater of: (1) The verifiable contracted amount paid by all eligible insurers subject to the
provisions of this chapter for the provision of the same or similar services as determined by the department; (2) The most recent verifiable amount agreed to by the insurer and the nonparticipating emergency medical provider for the provision of the same services during such time as such provider was in-network with such insurer; or (3) Such higher amount as the insurer may deem appropriate given the complexity and circumstances of the services provided.
Any amount that the insurer pays the nonparticipating provider under this subsection shall not be required to include any amount of coinsurance, co-payment, or deductible owed by the covered person or already paid by such person. For purposes of the covered person's financial responsibilities, the healthcare plan shall treat the emergency medical services received by the covered person from a nonparticipating provider or nonparticipating facility pursuant to this Code section as if such services were provided by a participating provider or participating facility, and shall include applying the covered person's cost-sharing for such services toward the covered person's deductible and maximum out-of-pocket limit applicable to services obtained from a participating provider or a participating facility under the healthcare plan. In the event a covered person receives a surprise bill for the provision of non-emergency medical services from a nonparticipating medical provider, the nonparticipating provider shall collect or bill the covered person no more than such person's deductible, coinsurance, co-payment, or
other cost-sharing amount as determined by such person's policy directly and such insurer shall directly pay such provider For purposes of the covered person's financial responsibilities, the healthcare plan shall treat the non-emergency medical services received by the covered person from a nonparticipating provider pursuant to this Code section as if such services were provided by a participating provider, and shall include applying the covered person's cost-sharing for such services toward the covered person's deductible and maximum out-of-pocket limit applicable to services obtained from a participating provider under the healthcare plan. No healthcare plan shall deny or restrict the provision of covered benefits from a participating provider to a covered person solely because the covered person obtained treatment from a nonparticipating provider leading to a balance bill. Notice of such protection shall be provided in writing to the covered person by the insurer. (a) Nothing in this chapter shall reduce a covered person's financial responsibilities in the event that such covered person chose to receive non-emergency medical services from an out-of-network provider. Such services shall not be considered a surprise bill.
The covered person's choice described in subsection (a) of this Code section must: (1) Be documented through such covered person's written and oral consent in advance of the provision of such services; and (2) Occur only after such person has been provided with an estimate of the potential charges. (c) If during the provision of non-emergency medical services, a covered person requests that the attending provider refer such covered person to another provider for the immediate provision of additional non-emergency medical services, such referred provider shall be exempt from the requirements in subsection (b) of this Code section if the following requirements are satisfied: (1) The referring provider advises the covered person that the referred provider may be a nonparticipating provider and may charge higher fees than a
participating provider; (2) The covered person orally and in writing acknowledges that he or she is aware that the referred provider may be a nonparticipating provider and may charge higher fees than a participating provider; (3) The written acknowledgment referenced in paragraph (2) of this subsection shall be on a document separate from other documents provided by the referring provider and shall include language to be determined by the Commissioner through rule and regulation; and (4) The referring provider records the satisfaction of the requirements in paragraphs (1), (2), and (3) of this subsection in the covered person's medical file. No nonparticipating provider shall report to any credit reporting agency any covered person who receives a surprise bill for the receipt of healthcare services from such provider and does not pay such provider any copay, coinsurance, deductible, or other cost-sharing amount beyond what such covered person would pay if such nonparticipating provider had been a participating provider.
Ga HB 888, https://www.legis.ga.gov/api/legislation/document/20192020/191890, effective 1/1/2021, provides consumer protections against balance billing for emergency medical services provided by non-participating providers. Consumers will be responsible for the deductible, copays, and out of pocket maximums on their plan, even if they received care from a nonparticipating provider/facility for an emergency. In the event that a covered person chose to receive non-emergency medical services from an out-of-network provider, such services shall not be considered a surprise bill. No nonparticipating provider shall report to any credit reporting agency any covered person who receives a surprise bill for the receipt of healthcare services from such provider and does not pay such provider any copay, coinsurance, deductible, or other cost-sharing amount beyond what such covered person would pay if such nonparticipating provider had been a participating provider.
