New Georgia law seeks to curb surprise billing in telehealth

Senate Bill 20, which takes effect in January, primarily seeks to remove barriers for access to telehealth that don't exist for in-person care. (NickyLloyd/E+/Getty Images/TNS)

Credit: TNS

Credit: TNS

Senate Bill 20, which takes effect in January, primarily seeks to remove barriers for access to telehealth that don't exist for in-person care. (NickyLloyd/E+/Getty Images/TNS)

After years of witnessing a growing telehealth industry, the Georgia General Assembly is aiming to fight surprise billing in the sector.

Senate Bill 20, passed by lawmakers in the last legislative session, seeks to end extra and unexpected costs that could be applied to patients who opt to obtain health care services virtually, via telehealth. It also works to ensure health insurance plans have an adequate array of options for patients. The law will take effect in January.

Telehealth usage surged during the coronavirus pandemic as patients and providers limited nonessential in-person care. An April federal Department of Health and Human Services report found that nationally usage has fallen since the peak of the virus’ spread but continues to be elevated over pre-pandemic levels.

Marietta Republican state Sen. Kay Kirkpatrick, the law’s lead sponsor, said it was important to make sure patients were being treated the same no matter the service they were seeking, especially as telehealth’s usage has risen.

“That has become a big part of medical practice, and it’s even more important that our insurance folks have the ability to police that,” Kirkpatrick said.

Surprise medical billing occurs when patients are charged for services they thought were covered by their insurer. To stop this in telehealth, the new law bans insurers from requiring clearances for patients to use telehealth that wouldn’t be required for in-person services, forcing patients to prove virtual treatment is necessary and denying coverage based solely on the technology used for the service. It also says insurers can’t require providers to have telehealth options or make patients attend telehealth appointments instead of visiting an out-of-network in-person provider.

The General Assembly passed legislation in 2019 clarifying rules and regulations for the telehealth industry in the state, but Kirkpatrick said the new law puts an “exclamation point” on the sector’s operations after the rise in its usage.

“It’s a way to protect telemedicine into the future and the use of it,” said state Rep. Lee Hawkins, a Gainesville Republican. Hawkins was the lead sponsor of the original legislation on surprise billing that SB 20 adds to.

As telehealth usage has risen, so have questions regarding insurance practices in the industry. However, a lack of transparency limits the ability to know whether anecdotal issues patients and providers report are actually widespread, Kirkpatrick said. That’s why SB 20 will require insurers to annually submit data to the state insurance commissioner related to compliance with the law’s provisions.

Liz Coyle, executive director of Georgia Watch, a consumer advocacy group, said the law will help patients avoid going through additional hoops to seek telehealth care, which she supports. That will particularly benefit patients in rural parts of the state, where geographical distance to in-person providers makes telehealth services appealing.

But Coyle has some concerns about SB 20′s provision regarding network adequacy, the standards governments set for health plans to have enough providers and services available to patients in their networks.

The law gives the insurance commissioner the power to assess network plans using a list of standards including federal rules and regulations, availability of in-network providers within a reasonable time and distance to patients, appointment wait times and more.

According to a spokesperson for the insurance commissioner’s office, the agency has conducted several reviews of network plans and will analyze them again once SB 20 takes effect.

Coyle supports the measure as a first step but worries it’s too vague to actually solve the problem. “While the bill sponsor’s intentions are outstanding ... we would have liked to see more specifics,” she said.

While Kirkpatrick acknowledged more work may need to be done, she thinks the policy as is with the added protections in telehealth will aid patients everywhere.

“I’m big on people knowing what they’re paying for when they buy an insurance plan,” she said. “The more we can bring transparency to it so it’s not like ‘The Wizard of Oz,’ that is positive for everybody.”