Bill > HB961

This bill, titled the "Surprise Billing Consumer Protection Act," amends existing Georgia law to ensure insurance coverage for certain out-of-network ambulance transportation services, aiming to protect consumers from unexpected medical bills. It defines key terms like "ambulance provider" (licensed agencies providing emergency transport), "covered service" (emergency transport covered by a healthcare plan), and "first responder" (including firefighters, paramedics, and law enforcement). The bill mandates that healthcare plans must cover emergency transport services when requested by a first responder or healthcare professional. For out-of-network ambulance providers, it establishes a minimum reimbursement rate, which is either the rate agreed upon by local government or, if no such agreement exists, a rate capped at 400% of the Medicare reimbursement rate for ambulance services or the provider's billed charges, whichever is lower. Importantly, any payment made to an ambulance provider is considered full payment except for the patient's standard copayment, coinsurance, or deductible, which cannot exceed what would be charged for in-network services, and providers are prohibited from billing patients for additional amounts. Insurers are required to pay ambulance providers directly within 30 days of receiving a complete claim, or provide specific reasons for denial or request for more information.

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https://www.legis.ga.gov/legislation/72210