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Georgia State Code
Title      49
Chapter       4  
Section Navigation     1 ... 10         11 ... 18    
    19 ... 38         50 ... 59    
    60 ... 100       101 ... 110   
   111 ... 120       121 ... 141   
   142 ... 147.1     147.2 ... 152.3 
 152.4 ... 172       173 ... 188   
   189 ... 192     
Section<<< 147.2 148 149 149.1 150 151 152 152.1 152.2 152.3 >>>  
Title 49, Chapter 4, Section 148 (49-4-148)

(a) Should medical assistance be paid in behalf of a recipient of medical assistance on account of any sickness, injury, disease, or disability for which another person is legally liable, the Department of Community Health may seek reimbursement for such medical assistance from such other person. The department shall be subrogated, but only to the extent of the reasonable value of the medical assistance paid and attributable to such sickness, injury, disease, or disability, to the rights of the recipient of medical assistance against the person so legally liable; the commissioner of community health may compromise, settle, and execute a release of any such claim or waive, expressly, any such claim, in whole or in part, for the convenience of the Department of Community Health. This Code section is cumulative of the remedies of the Department of Community Health which specifically include, but are not limited to, the use of hospital liens as provided in Code Sections 44-14-470 through 44-14-477; and further, the payment of medical assistance to a hospital provider shall in no way be construed to discharge the obligation of a third party to satisfy a hospital lien.

(b) All insurers, as defined in Code Section 33-24-57.1, including but not limited to group health plans as defined in Section 607(1) of the federal Employee Retirement Security Act of 1974 and managed care entities as defined in Code Section 33-20A-3, which offer health benefit plans, as defined in Code Section 33-24-59.5, shall comply with this subsection. Those insurers shall:

(1) Cooperate with the department in determining whether a person who is a recipient of medical assistance may be covered under that insurer's health benefit plan and eligible to receive benefits thereunder for the medical services for which that medical assistance was provided;

(2) Accept the department's authorization for the provision of medical services on behalf of a recipient of medical assistance as the insurer's authorization for the provision of those services; and

(3) Comply with the requirements of Code Section 33-24-59.5, regarding the timely payment of claims submitted by the department for medical services provided to a recipient of medical assistance and covered by the health benefit plan, subject to the payment to the department of interest as provided in that Code section for failure to comply.

The requirements of paragraphs (2) and (3) of this subsection shall only apply to a health benefit plan which is issued, issued for delivery, delivered, or renewed on or after April 28, 2001.

Saturday May 23 18:59 EDT


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