Georgia Balance Billing Law

Overview

Georgia SB 359 (2020 Patient Billing Act) prohibits balance billing for emergency services and OON providers at in-network facilities. Patients cannot be charged more than their in-network cost-sharing. Disputes over $750 are resolved through arbitration. The Georgia Department of Insurance oversees compliance.

Key Requirements

1. Emergency services are protected from balance billing regardless of provider network status.
2. OON providers at in-network facilities cannot bill patients beyond in-network cost-sharing.
3. Plans must maintain dispute resolution processes for balance billing claims.
4. Disputes over $750 must be resolved through binding arbitration within 30-60 days.
5. Patients can file complaints with Georgia Department of Insurance for violations.

Penalties and Enforcement

Georgia Department of Insurance enforces SB 359 with regulatory action and consumer restitution orders. Plans that systematically engage in balance billing face fines and license restrictions. Arbitration decisions are binding. Enforcement investigations often result in significant penalties.

Appeals and Exceptions

Disputed balance billing charges can be appealed through plan review or escalated to arbitration for disputes over $750. Arbitration decisions are binding and final. No exceptions exist for emergency services or OON facility scenarios.

Interaction with Federal Law

Georgia SB 359 aligns with federal No Surprises Act protections for emergency and facility-based services. Georgia enforcement is independent. SB 359 arbitration provisions provide additional consumer remedies beyond federal law.

Common Questions