Evaluation of Person With Emergency Condition; Initiation of Intervention Without Prospective Authorization; Insurer May Not Deny Payment After Prospective Authorization Given

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  2. Georgia Code
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  4. Emergency Medical Services
  5. Emergency Services
  6. Evaluation of Person With Emergency Condition; Initiation of Intervention Without Prospective Authorization; Insurer May Not Deny Payment After Prospective Authorization Given

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  1. Once a person with an emergency condition presents himself or herself to an emergency medical provider for emergency services, that person shall be evaluated by medical personnel. This evaluation may include diagnostic testing to assess the extent of the condition, sickness, or injury if such testing is appropriate to stabilize the patient's condition. For purposes of this Code section, the term "emergency medical provider" includes without limitation an emergency services provider.
  2. If in the opinion of the attending physician or licensed ambulance service personnel acting under the medical direction of an ambulance service medical director as defined in Code Section 31-11-60.1 the evaluation provided under subsection (a) of this Code section warrants, he or she may initiate appropriate intervention to stabilize the condition of the patient without seeking or receiving prospective authorization by an insurer, a health maintenance organization, or a private health benefit plan. No insurer, health maintenance organization, or private health benefit plan may subsequently deny payment for an evaluation, diagnostic testing, or treatment provided as part of such intervention for an emergency condition.
  3. No insurer, health maintenance organization, or private health benefit plan which has given prospective authorization after the stabilization of a person's condition as provided in subsection (b) of this Code section for an evaluation, diagnostic testing, or treatment provided for in this article may subsequently deny payment for the provision of such evaluation, diagnostic testing, or treatment. An acknowledgment of an enrollee's eligibility for benefits by the insurer, health maintenance organization, or private health benefit plan shall not, by itself, be construed as a prospective authorization for the purposes of this Code section.

(Code 1981, §31-11-82, enacted by Ga. L. 1996, p. 668, § 1; Ga. L. 1997, p. 908, § 1; Ga. L. 2006, p. 652, § 2/HB 1257.)

Code Commission notes.

- Pursuant to Code Section 28-9-5, in 1996, a comma was deleted following "attending physician" at the beginning of subsection (b).

ARTICLE 5 GEORGIA TRAUMA CARE NETWORK COMMISSION


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