Ga. Comp. R. & Regs. R. 120-2-106-.08 - Covered Person Choosing to receive Non-emergency medical Services from a non-participating provider, Referrals and Procedures

(1) Nothing in this chapter shall reduce a covered person's financial responsibilities in the event that such covered person chose to receive non-emergency medical services from an out-of-network provider. Such services shall not be considered a surprise bill for the purpose of this chapter.

(2) The covered person's choice described in subsection (1) of this Code section must:

(a) Be documented through such covered person's written and oral consent in advance of the provision of such services; and

(b) Occur only after such person has been provided with an estimate of the potential charges.

(3) If during the provision of non-emergency medical services, a covered person requests that the attending provider refer such covered person to another provider for the immediate provision of additional non-emergency medical services, such referred provider shall be exempt from the requirements in subsection (b) of this Code section if the following requirements are satisfied:

(a) The referring provider advises the covered person that the referred provider may be a non-participating provider and may charge higher fees than a participating provider;

(b) The covered person orally and in writing acknowledges that he or she is aware that the referred provider may be a non-participating provider and may charge higher fees than a participating provider;

(c) The written acknowledgment referenced in paragraph (2) of this subsection shall be on a document separate from other documents provided by the referring provider and shall include language to be determined by the Commissioner (Appendix A) and Regulation; and

(d) The referring provider records the satisfaction of the requirements in paragraphs (1), (2), and (3) of this subsection in the covered person's medical file.

Notes

Ga. Comp. R. & Regs. R. 120-2-106-.08

O.C.G.A. §§ 33-2-9, 33-20E.

Original Rule entitled "Covered Person Choosing to receive Non-emergency medical Services from a non-participating provider, Referrals and Procedures" adopted. F. Dec. 7, 2020; eff. Jan. 1, 2021, as specified by the Agency.