Applicability of Provisions of Title and of Other Laws to Health Maintenance Organizations and Representatives

1. Law
2. Georgia Code
3. Insurance
4. Health Maintenance Organizations
5. Applicability of Provisions of Title and of Other Laws to Health Maintenance Organizations and Representatives

1. 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.
2. 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.
3. 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.

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

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).

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