Georgia Surprise Billing Law

Overview

Georgia SB 359 established surprise billing protections effective January 1, 2021. Emergency services are protected at in-network rates. OON providers at in-network facilities cannot charge more than in-network cost-sharing. Disputes are resolved through plan review or arbitration. Georgia Department of Insurance oversees compliance.

Key Requirements

1. Emergency services are protected under SB 359 regardless of network status.
2. OON providers at in-network facilities cannot charge more than in-network cost-sharing.
3. Plans must resolve disputes within specified timelines.
4. Disputes over $750 are resolved through binding arbitration.
5. Georgia DOI can investigate complaints related to SB 359 violations.

Penalties and Enforcement

Georgia Department of Insurance enforces SB 359 surprise billing violations with regulatory action and consumer restitution. Plans and providers that systematically violate the law face fines and license restrictions. Arbitration decisions are binding. Enforcement often results in significant penalties.

Appeals and Exceptions

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

Interaction with Federal Law

Georgia SB 359 provides state-level protections aligned with the federal No Surprises Act. Both cover emergency and OON facility services. Georgia's arbitration process provides additional consumer remedies beyond federal law.

Common Questions