Insurers offering polices through the Georgia’s health benefits plan would be required to include in their service networks Level I trauma centers under legislation state lawmakers advanced this week.
There are five Level I trauma centers in the state: Atlanta Medical Center, Grady Memorial Hospital in Atlanta, the Medical Center of Central Georgia in Macon, Georgia Regents Medical Center in Augusta and Memorial Health University Medical Center in Savannah.
Under House Bill 354, insurers who don't include the Level I trauma centers located in their defined service areas would be barred from entering into contracts with the state to provide health benefit policies.
Sponsored by Republican state Rep. Barry Fleming of Harlem, HB 354 won approval in a House subcommittee Wednesday. The legislation stems from a dispute that began months ago between Grady and Blue Cross and Blue Shield. Contract renewal talks foundered and a coverage agreement between the two expired. Thousands of Blue Cross customers who currently use Grady have been charged “out of network” prices.
Grady has accused Blue Cross of paying it less than it pays other hospitals for outpatient services. Blue Cross has said the state’s leading trauma hospital wants a rate increase “several times” the rate of inflation, and that the insurer would have to charge consumers more to pay it.
HB 354 would also set up an arbitration process for insurers and hospitals providing services under the state’s health benefit plan. Through the bill, those that that cannot agree on contract terms may appeal to the state commissioner of insurance. The commissioner would then appoint a three-member arbitration panel to issue a binding decision. The parties in the dispute would be allowed to appeal the panel’s decision in the Fulton County Superior Court.
A similar measure, Senate Bill 143, is pending in the Senate.
About the Author
