O.C.G.A.

O.C.G.A. § 33-20-16 (2019)

Right to become participating physician or approved health care provider

✓ O.C.G.A. — 2019 edition (Public.Resource.Org Release 73)

Code text and O.C.G.A. statutory annotations on this page reflect the 2019 Official Code of Georgia Annotated (Public.Resource.Org Release 73, 2019-08-21; public domain per Georgia v. Public.Resource.Org, 2020). The Syfert case-law annotations in Notes of Decisions, below, are current.

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Every doctor of medicine, every doctor of dental surgery, every podiatrist, and every health care provider within a class approved by the health care corporation who is appropriately licensed to practice and who is reputable and in good standing shall have the right to become a participating physician or approved health care provider for medical or surgical care, or both, as the case may be, under such terms or conditions as are imposed on other participating physicians or approved health care providers within such approved class under similar circumstances in accordance with this chapter.

History

Code 1933, § 56-1712a, enacted by Ga. L. 1976, p. 1461, § 1.

Annotations

Law reviews. - For annual survey on

administrative law, see 61 Mercer L. Rev. 1 (2009).

JUDICIAL DECISIONS ‘‘Any Willing Provider’’ (AWP) statute did not apply to a health maintenance organization (HMO) because: (1) the statute did not apply to for-profit corporations not statutorily defined as ‘‘surviving corporations,’’ and (2) the HMO had never been an O.C.G.A. T. 33, Ch. 20 health care corporation, nor was the HMO an insurer’s subsidiary any longer, so the HMO was not a surviving corporation,

and O.C.G.A. § 33-21-28(a) barred applying the AWP statute to the HMO. Northeast Ga. Cancer Care, LLC v. Blue Cross & Blue Shield of Ga., Inc., 315 Ga. App. 521, 726 S.E.2d 714 (2012), cert. denied, No. S12C1322, 2012 Ga. LEXIS 1018 (Ga. 2012), cert. denied, No. S12C1413, 2012 Ga. LEXIS 1033 (Ga. 2012). Exhaustion of remedies required. - Medical group’s suit for a declaratory

judgment as to the group’s rights to participate in a health maintenance organization under Georgia’s Any Willing Provider Statute, O.C.G.A. § 33-20-16, was procedurally barred by the failure to exhaust administrative remedies by first submitting the group’s dispute to the Georgia Insurance Commissioner pursuant to O.C.G.A. § 33-20-30. Northeast Ga. Cancer Care, LLC v. Blue Cross & Blue Shield of Ga., Inc., 297 Ga. App. 28, 676 S.E.2d 428 (2009), cert. denied, No. S09C1241, 2009 Ga. LEXIS 805 (Ga. 2009). ‘‘Any Willing Provider’’ (AWP) statute applied to a health insurer’s preferred provider (PPO) network be-

cause: (1) the insurer was an O.C.G.A. T. 33, Ch. 20 health care corporation; (2) the AWP statute expressly applied to health care corporations; and (3) the AWP statute applied to the PPO network since the insurer, under the Preferred Provider Arrangements Act, O.C.G.A. § 33-30-20 et seq., could administer a preferred provider arrangement which was a health benefit plan. Northeast Ga. Cancer Care, LLC v. Blue Cross & Blue Shield of Ga., Inc., 315 Ga. App. 521, 726 S.E.2d 714 (2012), cert. denied, No. S12C1322, 2012 Ga. LEXIS 1018 (Ga. 2012), cert. denied, No. S12C1413, 2012 Ga. LEXIS 1033 (Ga. 2012).

Notes of Decisions

Cited in 3 cases (1 in the last 5 years), 2009–2023 · leading case: Ne. Georgia Cancer Care v. Blue Cross, 726 S.E.2d 714 (Ga. Ct. App. 2012).

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Ne. Georgia Cancer Care v. Blue Cross, 726 S.E.2d 714 (Ga. Ct. App. 2012). · cites it 20× “("Blue Cross") was required to admit "any willing provider" that wished to join its preferred provider arrangement, and that Blue Cross Blue Shield Healthcare Plan of Georgia, Inc.”

Ne. Georgia Cancer Care, LLC v. Blue Cross & Blue Shield of Georgia, Inc., 676 S.E.2d 428 (Ga. Ct. App. 2009). · cites it 4× “In its declaratory judgment claim, Northeast sought a statutory construction of the AWP statute, OCGA § 33-20-16. 2 According to Northeast, the AWP statute mandates that Northeast and its medical oncologists be allowed to participate as providers in the Blue Cross HMO network…”

AIDS Healthcare Found. v. Express Scripts, Inc. (E.D. Mo. 2023). “; (5) Georgia law, O.C.G.A. § 33-20-16; (6) Illinois Managed Care Reform and Patient Rights Act, 215 CS 134/72(A); and (7) Mississippi Code, Miss.”

Annotations are extracted automatically from the opinions in the Syfert caselaw corpus and ranked by authority, recency, and treatment. Dots show Syfertize treatment of the citing case itself.