Bill > HB961

This bill amends the "Surprise Billing Consumer Protection Act" in Georgia to ensure insurance coverage for certain out-of-network ambulance transportation services, addressing situations where individuals might receive unexpected bills. It defines key terms like "ambulance provider," "covered service," and "medical necessity" to clarify when these services are eligible for insurance. The bill establishes a minimum reimbursement rate for these out-of-network services, which will be either a contractually agreed-upon rate or, if no agreement exists, 300% of the Medicare reimbursement rate. Importantly, it limits a patient's financial responsibility to only their standard copayment, coinsurance, or deductible, meaning the insurer will pay the ambulance provider directly, and the patient will not be responsible for any difference beyond their usual out-of-pocket costs. Insurers are also required to process claims from out-of-network ambulance providers within 30 days and provide clear reasons if a claim is denied or requires additional information.

Business and Industry, Health and Social Services

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