O.C.G.A.

O.C.G.A. § 33-21-28 (2019)

Applicability of provisions of title and of other laws to health maintenance organizations and representatives

✓ 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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(a) Except as otherwise provided by law, all provisions of this title which are not in conflict with this chapter shall apply to health maintenance organizations and all other persons subject to this chapter, and specifically, the requirements and restrictions of Code Sections 33-20A-6, 33-20A-7, 33-20A-8, and 33-20A-9.1 shall apply to health maintenance organizations and all other persons subject to this chapter. (b) Solicitation of enrollees by a health maintenance organization granted a certificate of authority or its representatives shall not be

construed to violate any provision of law relating to solicitation or advertising by health professionals. (c) Any health maintenance organization authorized under this chapter shall not be deemed to be practicing medicine and shall be exempt from the provision of Chapter 34 of Title 43, relating to the practice of medicine.

History

Code 1933, § 56-3623, enacted by Ga. L. 1979, p. 1148, § 1; Ga. L. 1999, p. 342, § 6.

Annotations

Code Commission notes. - Pursuant to Code Section 28-9-5, in 1999,

‘‘33-20A-7.1’’ was deleted following ‘‘33-20A-7’’ in subsection (a). Law reviews. - For note on 1999 amendment to this Code section, see 16 Ga. St. U.L. Rev. 163 (1999).

JUDICIAL DECISIONS Applicability of O.C.G.A. § 33-20-16. - ‘‘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, C. 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). Exhuastion of remedies. - 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).

Notes of Decisions

Cited in 2 cases, 2009–2012 · 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 28× “First, the Commissioner reasoned that pursuant to OCGA § 33-21-28 (a), any provision in Title 33 that did not conflict with the provisions of Chapter 21 applied to HMOs; and he found no such conflict.”

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× “OCGA § 33-20-30 applies to disputes concerning the regulation and supervision of HMOs pursuant to OCGA § 33-21-28 (a). 4 And, significantly, the Insurance Rules and Regulations provide a procedure in which an interested person may obtain a declaratory ruling by the Commissioner…”

— 33-21-28(a) — 1 case

Ne. Georgia Cancer Care v. Blue Cross, 726 S.E.2d 714 (Ga. Ct. App. 2012). “First, the Commissioner reasoned that pursuant to OCGA § 33-21-28 (a), any provision in Title 33 that did not conflict with the provisions of Chapter 21 applied to HMOs; and he found no such conflict.”

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