No Surprises Act of 2022 (Georgia HB 888)

Your Rights and Protections Against Surprise Medical Bills

(OMB Control Number: 0938-1401)

When you get emergency care or get treatment by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.

What is “balance billing” (sometimes called “surprise billing”)?

 

When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.

 

“Out-of-network” describes providers and facilities that haven’t signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called “balance billing”. This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit.

 

“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care. For example, when you have an emergency, or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider, this is surprise or balance billing.

 

You are protected from balance billing for:

Emergency services

If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most the provider or facility may bill you is your plan’s in-network cost-sharing amount (such as copayments and coinsurance). You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.

Certain services at an in-network hospital or ambulatory surgical center

When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers may bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed.

 

If you get other services at these in-network facilities, out-of-network providers can’t balance bill you unless you give written consent and give up your protections.

 

You’re never required to give up your protection from balance billing. You also aren’t required to get care out-of-network. You can choose a provider or facility in your plan’s network.

When balance billing isn’t allowed, you also have the following protections:

 

  • You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). Your health plan will pay out-of-network providers and facilities directly.

  • Your health plan generally must:​

    • Cover emergency services without requiring you to get approval for services in advance (prior authorization).​

    • Cover emergency services by out-of-network providers.​

    • Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.​

    • Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.

What Do You Do if You Get a Surprise Medical Bill?

If you believe you’ve been wrongly billed, you may contact: the Georgia Secretary of State sos.ga.gov at the state capital building 214 State Capital, Atlanta, GA 30334. The telephone number is 404-656-2881. The email contact form can be found here.

 

You may also contact The Georgia Office of Commissioner of Insurance and Safety Fire at (800) 656-2298

 or visit them at the following address: 2 M.L.K. Jr Dr SE #716, Atlanta, Georgia 30334

Visit and download Model Disclosure Notice Regarding Patient Protections Against Surprise Billing (PDF) for more information about your rights under Federal law.

 

Visit Georgia General Assembly's website to read more information about your rights under Georgia State law HB 888 Surprise Billing Consumer Protection Act.

Ethics Boards, State Licenses, and Filing a Complaint

Ethics boards and state licenses are meant to protect consumers, clients, and patients, and ensure ethical, competent care. If you have questions or concerns about a mental health care provider, you can contact the licensing agency in the state where you received services.

 

You can also check a provider's license to make sure it is current and unencumbered. A license becomes encumbered when a complaint against a provider is found to be credible and the licensing board limits their license while they are working a corrective action plan. Sometimes the license look-up page will even list if anyone has made a complaint against that provider in the past.

 

Here are the ones that pertain to me:

 

Registered in Florida to provide tele-mental health, registration #345. Florida's website doesn't appear to have a search function. But you can write to them and they keep a list to current registered providers.

Georgia Secretary of State

I am licensed as an LCSW social worker, #CSW 005566

 

South Carolina Secretary of State

I am licensed as an LISW-CP social worker, #13457