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2018 Georgia Code 33-24-54 | Car Wreck Lawyer

Link to State of Georgia Official Statute 2018 Georgia Code Annotated (sourced from legal.resource.org)
O.C.G.A. 33-24-54 Case Law from Google Scholar Amendments to OCGA 33-24-54

TITLE 33 INSURANCE

Section 24. Insurance Generally, 33-24-1 through 33-24-98.

ARTICLE 1 GENERAL PROVISIONS

33-24-54. Payments to nonparticipating or nonpreferred providers of health care services.

  1. Notwithstanding any provisions of Code Sections 33-1-3, 33-1-5, and 33-24-17 and Chapter 20 of this title or any other provisions of this title which might be construed to the contrary, whenever an accident and sickness insurance policy, subscriber contract, or self-insured health benefit plan, by whatever name called, which is issued or administered by a person licensed under this title provides that any of its benefits are payable to a participating or preferred provider of health care services licensed under the provisions of Chapter 4 of Title 26 or of Chapter 9, 11, 30, 34, 35, or 39 of Title 43 or of Chapter 11 of Title 31 for services rendered, the person licensed under this title shall be required to pay such benefits either directly to any similarly licensed nonparticipating or nonpreferred provider who has rendered such services, has a written assignment of benefits, and has caused written notice of such assignment to be given to the person licensed under this title or jointly to such nonparticipating or nonpreferred provider and to the insured, subscriber, or other covered person; provided, however, that in either case the person licensed under this title shall be required to send such benefit payments directly to the provider who has the written assignment. When payment is made directly to a provider of health care services as authorized by this Code section, the person licensed under this title shall give written notice of such payment to the insured, subscriber, or other covered person.
  2. Nothing contained in this Code section shall be deemed to prohibit the payment of different levels of benefits or from having differences in coinsurance percentages applicable to benefit levels for services provided by participating or preferred providers and nonparticipating or nonpreferred providers as otherwise authorized under the provisions of Code Sections 33-30-20 through 33-30-27.
  3. Payments made by a person licensed under this title under subsection (a) of this Code section to a nonparticipating or nonpreferred provider or jointly to the provider and the insured, subscriber, or other covered person shall discharge such person's obligation with respect to the amount so paid.
  4. The provisions of this Code section shall not apply to credit insurance, disability income insurance, or limited accident and sickness policies such as hospital indemnity policies, specified disease policies, limited accident policies, or similar limited policies.

(Code 1981, §33-24-54, enacted by Ga. L. 1992, p. 1184, § 2; Ga. L. 2006, p. 652, § 4/HB 1257.)

JUDICIAL DECISIONS

Anti-assignment clauses.

- Physician could not bring suit against a health care plan because a patient's assignment to the physician of the right to payment of benefits was voided by the plan's unambiguous anti-assignment provision; Georgia law neither required assignment of benefits to health care providers nor barred anti-assignment provisions. Griffin v. Habitat for Humanity Int'l, Inc., F.3d (11th Cir. Feb. 2, 2016)(Unpublished).

District court properly dismissed the healthcare provider's action against an employer seeking payment of benefits and penalties under the Employment Retirement Income Security Act (ERISA), 29 U.S.C. § 1001, et seq., because the provider lacked standing to file an ERISA claim based upon unambiguous anti-assignment provision in the plan and the lack of a written assignment from the member; further, nothing in O.C.G.A. § 33-24-54 explicitly prohibited health benefits plan from barring assignment so the statute did not render anti-assignment provisions unenforceable, and the provider pled no facts setting forth clear case of implied waiver of anti-assignment clause by the employer or showing that the employer expressly waived anti-assignment clause such that estoppel applied. Griffin v. Coca-Cola Enters., F.3d (11th Cir. Apr. 27, 2017)(Unpublished).

Anti-assignment provision not void.

- After a doctor appealed a district court's dismissal of the doctor's case, because an anti-assignment provision in the plan under the Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1001 et seq., barred assignments, the insureds' assignments to the doctor were void and the anti-assignment provision was not void under O.C.G.A. § 33-24-54. Griffin v. Verizon Communs., Inc., F.3d (11th Cir. Jan. 12, 2016)(Unpublished).

Anti-assignment provisions impact on benefits' recovery.

- Healthcare provider who had been assigned patients' rights under a medical benefits plan that contained an anti-assignment provision could not state a claim to recover benefits; the anti-assignment provision was not unenforceable under O.C.G.A. § 33-24-54, which neither explicitly nor implicitly prohibits a health benefits plan from barring assignment. Griffin v. S. Co. Servs., F.3d (11th Cir. Dec. 30, 2015)(Unpublished).

Anit-assignment provision enforceable.

- Healthcare provider could not bring suit against a plan sponsor to recover benefits because the insured's assignment of the right to payment to the provider was void under the plan's anti-assignment provision; the anti-assignment provision was not unenforceable under O.C.G.A. § 33-24-54, which does not explicitly or implicitly prohibit a health benefits plan from barring assignment. Griffin v. FOCUS Brands, Inc., F.3d (11th Cir. Dec. 30, 2015)(Unpublished).

Anti-assignment provision not enforceable.

- Dermatologist who had been assigned ERISA benefits by the dermatologist's patients lacked standing to bring a 29 U.S.C. § 1132(a)(1)(B) claim against an employer when the wrap document governing the healthcare plan at issue contained an unambiguous anti-assignment clause, and even if O.C.G.A. § 33-24-54 mandated the recognition of assignments of benefits in an insurance contract, it was preempted by ERISA. Griffin v. Southern Co. Servs., F. Supp. 2d (N.D. Ga. May 12, 2015).

Payments.

- O.C.G.A. § 33-24-54 guarantees that if benefits are payable to preferred or participating providers under a plan, the plan must also pay benefits to non-participating or non-preferred healthcare providers to whom patients have assigned their rights. But nothing in § 33-24-54 requires an insured to assign the insured's benefits to a medical provider or renders a plan's anti-assignment provision unenforceable. Griffin v. Health Sys. Mgmt., F.3d (11th Cir. Dec. 29, 2015)(Unpublished).

Payment of benefits.

- O.C.G.A. § 33-24-54 guarantees that if benefits are payable to preferred or participating providers under a plan, the plan must also pay benefits to non-participating or non-preferred healthcare providers to whom patients have assigned their rights. But nothing in § 33-24-54 requires an insured to assign the insured's benefits to a medical provider or renders a plan's anti-assignment provision unenforceable. Griffin v. Gen. Mills, Inc., F.3d (11th Cir. Dec. 29, 2015)(Unpublished).

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