Syfert Injury Law Firm

Your Trusted Partner in Personal Injury & Workers' Compensation

Call Now: 904-383-7448
O.C.G.A. § 33-20-16 — Right to become participating physician or approved health care provider | Georgia Code
O.C.G.A. § 33-20-16 (2018) Copy Cite Official Site Syfertize CourtListener Scholar Amendments

TITLE 33 INSURANCE

Section 20. Health Care Plans, 33-20-1 through 33-20-34.

ARTICLE 7 MISCELLANEOUS PROVISIONS

33-20-16. Right to become participating physician or approved health care provider.

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.

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

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 because: (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).

Database error: SQLSTATE[HY000]: General error: 8 attempt to write a readonly database

This Georgia Code resource is curated by an Orange Park personal injury and workers' comp lawyer, a personal injury and workers' compensation attorney admitted in Georgia (State Bar of Georgia No. 881027, since 2006) and Florida. Attorney Syfert regularly works with Title 33 in the context of Georgia insurance coverage law and represents clients throughout Northeast Florida and South Georgia. For legal consultation, call 904-383-7448.