Georgia Billing Rights

Additional State-Law Protections for Patients with State-Regulated Health Plans

Under Georgia’ Surprise Billing Consumer Protection Act:

• In the event a covered person receives the provision of emergency medical services from a nonparticipating emergency medical provider or emergency medical services from a nonparticipating facility, the nonparticipating provider or nonparticipating facility may not collect or bill more than the covered person’s deductible, coinsurance, copayment, or other cost-sharing amount as determined by the person’s policy directly.
• In the event a covered person receives a surprise bill for the provision of nonemergency 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, copayment, or other cost-sharing amount as determined by such person’s policy directly.
• Georgia defines:
  • A “surprise bill” as a bill resulting from an occurrence in which charges arise from a covered person receiving healthcare services from an out-of-network provider at an in-network facility
  • A “provider” as any physician, other individual, or facility other than a hospital licensed or otherwise authorized in this state to furnish healthcare services, including, but not limited to, any dentist, podiatrist, optometrist, psychologist, clinical social worker, advanced practice registered nurse, registered optician, licensed professional counselor, physical therapist, marriage and family therapist, chiropractor, athletic trainer, occupational therapist, speech-language pathologist, audiologist, dietitian, or physician assistant
  • A “facility” as a hospital, an ambulatory surgical treatment center, birthing center, diagnostic and treatment center, hospice, or similar institution

Self-funded plans may opt-in to Georgia’s Surprise Billing Consumer Protection Act.

Filing a Complaint

If you think you’ve been sent a bill you should not have to pay, file a complaint with your insurer. Then file a complaint with the Office of the Commissioner of Insurance and Safety Fire online at gaoci.govlink.us/surprise-billing/home or at 404-656-2070.

State Agency Contact Information

Georgia Office of the Commissioner of Insurance and Safety Fire

Phone: 404-656-2070
Website: https://gaoci.govlink.us/surprise-billing/home

Additional Information

Visit www.cms.gov/nosurprises/consumers or call 800-985-3059 for more information about your rights under federal law.