Georgia’s surprise medical billing law goes into effect Sunday

Hospital surgery corridor
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Health-care transparency legislation aimed at filling a gap in Georgia’s new surprise billing law will take effect this Sunday, in time for the annual insurance enrollment period.

House Bill 789 will establish a rating system Georgians can use to determine which physician specialty groups in their insurance plan’s provider network serve a given hospital.

The legislation will apply to anesthesiologists, pathologists, radiologists and emergency room doctors, typically specialists responsible for the most incidents of surprise billing, the extra hospital charges that result from procedures performed by out-of-network specialists.

The surprise billing legislation that gained the most attention during this year’s General Assembly session applies only to health insurance plans regulated by the state, Georgia Rep. Mark Newton, R-Augusta, House Bill 789’s chief sponsor, said Monday.

Newton’s companion bill is aimed at the approximately 60% of Georgians enrolled in plans that are exempt from state regulation, typically large employer plans regulated through federal law.

“The public deserves to know when they go to an emergency room if the doctor who fixes their kid’s leg or sews them up is in their [insurance plan’s network],” said Newton, who works as an emergency room doctor.

Under House Bill 789, when an insurance company advertises a hospital as in its coverage network, the insurer will be required to disclose that hospital’s “surprise bill rating.” If the hospital’s rating is less than four, the insurer will have to disclose which of the four specialties are not in its network.

Ethan James, executive vice president for external affairs at the Georgia Hospital Association, said the legislation originally called for using a “star” system to rate hospitals, prompting concerns that patients could confuse the rating with the hospital’s quality of care.

The rating system was changed as the bill went through the House to use red lights and green lights to indicate how many specialties are within a hospital’s network, he said.

James said the legislation will go a long way toward easing patients’ concerns over how much their health care will cost.

“A patient cannot heal physically if they are stressed financially,” he said. “[Now], patients will have this information when making health-care decisions.”

The legislation requires insurance companies to post hospital ratings on their websites for easy consumer access.

But Newton said he hopes the ratings system eventually will be used primarily by the human resources officers who buy insurance plans for large employers, leaving consumers free from the hassle of doing their own research.

That’s likely to happen because the disclosure the legislation requires will serve as an incentive for insurance companies to work with hospitals and specialists to offer patients robust coverage plans, he said.

“What we want is the transparency spotlight to be on the insurer, the hospital and the [specialty] provider,” Newton said. “It’s going to put pressure on all of them to come up with four checks.”

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