Prohibition Against Requiring Referral From Primary Care Physician to Dermatologist

  1. Law
  2. Georgia Code
  3. Insurance
  4. Insurance Generally
  5. General Provisions
  6. Prohibition Against Requiring Referral From Primary Care Physician to Dermatologist

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  1. It is the intent of the General Assembly to encourage health care cost containment while preserving the quality of care offered to citizens of this state. The General Assembly finds that there is an increasing number of health insurance benefit providers which require a referral from a primary care physician to a dermatologist as a condition of the payment of benefits to an insured patient. The General Assembly finds that such a requirement as it relates to dermatological services may block unfairly a patient's choice of direct access to providers of health care services and may not be in the public interest.
  2. As used in this Code section, the term:
    1. "Dermatological services" means services ordinarily and customarily rendered by a physician specializing in the practice of dermatology.
    2. "Health benefit policy" means any individual or group plan, policy, or contract for health care services issued, delivered, issued for delivery, or renewed in this state by a health care corporation, health maintenance organization, accident and sickness insurer, fraternal benefit society, or similar entity.
  3. No health benefit policy which is issued, delivered, issued for delivery, or renewed in this state shall require as a condition to the coverage of dermatological services that an enrollee, subscriber, or insured first obtain a referral from a primary care physician, as such term is defined by the group plan, policy, or contract for health care services.

(Code 1981, §33-24-56, enacted by Ga. L. 1995, p. 235, § 1; Ga. L. 2017, p. 164, § 28/HB 127; Ga. L. 2019, p. 386, § 53/SB 133.)

The 2019 amendment, effective July 1, 2019, deleted "on or after July 1, 1995," following "renewed in this state" near the middle of subsection (c).

Law reviews.

- For annual survey article discussing developments in insurance law, see 51 Mercer L. Rev. 313 (1999).


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