2020 Georgia Code
Title 33 - Insurance
Chapter 20 - Health Care Plans
§ 33-20-16. Right to Become Participating Physician or Approved Health Care Provider

Every doctor of medicine, every doctor of dental surgery, every podiatrist, and every health care provider within a class approved by the health care corporation who is appropriately licensed to practice and who is reputable and in good standing shall have the right to become a participating physician or approved health care provider for medical or surgical care, or both, as the case may be, under such terms or conditions as are imposed on other participating physicians or approved health care providers within such approved class under similar circumstances in accordance with this chapter.

(Code 1933, § 56-1712a, enacted by Ga. L. 1976, p. 1461, § 1.)

- For annual survey on administrative law, see 61 Mercer L. Rev. 1 (2009).

"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, Ch. 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).

- 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).

"Any Willing Provider" (AWP) statute applied to a health insurer's preferred provider (PPO) network because: (1) the insurer was an O.C.G.A. T. 33, Ch. 20 health care corporation; (2) the AWP statute expressly applied to health care corporations; and (3) the AWP statute applied to the PPO network since the insurer, under the Preferred Provider Arrangements Act, O.C.G.A. § 33-30-20 et seq., could administer a preferred provider arrangement which was a health benefit plan. 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).