Court Opinion

ID: 9780774
Source: CourtListenerOpinion
Date Created: 2023-08-30 02:51:41.478402+00
Date Added: 2024-06-11T12:09:17.330449
License: Public Domain

BARNES, Presiding Judge,
concurring in part and dissenting in part.
The majority reverses the superior court in part and holds that Blue Cross and Blue Shield of Georgia, Inc. must admit “any willing provider” into its health plan utilizing a preferred provider arrangement (“PPO plan”). But OCGA § 33-30-25 of the Preferred Provider Arrangements Act clearly permits health care insurers like Blue Cross to place reasonable limits on the number or classes of their preferred providers. Furthermore, Georgia’s Commissioner of Insurance has exercised his discretion and chosen not to require health care insurers to seek and obtain preapproval of the limits they wish to impose on the number or classes of their preferred providers. Under these circumstances, Georgia’s Any Willing Provider (“AWP”) statute is inapplicable to the PPO plan offered by Blue Cross, as the superior court properly concluded. Because the superior court should be affirmed on the PPO issue, I respectfully dissent in part to the majority’s decision in these companion appeals.16 *536(Citations and punctuation omitted.) Palmyra Park Hosp. v. Phoebe Sumter Med. Center, 310 Ga. App. 487, 491 (1) (714 SE2d 71) (2011). See OCGA§ 33-2-28 (c); Handel v. Powell, 284 Ga. 550, 553 (670 SE2d 62) (2008).
*535While reviewing courts defer to agency interpretations of the statutes they are charged with administering, that deference applies only as far as the agency interpretation is consistent with the statute. Administrative agencies may not change a statute by interpretation, or establish different standards within a statute that are not established by a legislative body. . . . The judicial branch determines independently whether the agency’s interpretation correctly reflects the plain language of the statute and comports with the legislative intent.
*536When interpreting a statute, this court must “apply the fundamental rules of statutory construction that require us to construe the statute according to its terms, to give words their plain and ordinary meaning, and to avoid a construction that makes some language mere surplusage.” (Punctuation and footnote omitted.) Ga. Transmission Corp. v. Worley, 312 Ga. App. 855, 856 (720 SE2d 305) (2011). Moreover, when two statutes conflict, “later statutes prevail over earlier statutes, and specific statutes govern over more general statutes.” (Citations omitted.) Glinton v. And R, Inc., 271 Ga. 864, 866-867 (524 SE2d 481) (1999). In the context of conflicts within the Insurance Code, “[provisions . . . relating to a particular kind of insurance or to a particular type of insurer or to a particular matter prevail over provisions relating to insurance in general or to insurers in general.” OCGA§ 33-1-5.
At the center of the parties’ dispute over statutory interpretation is the AWP statute, OCGA § 33-20-16, which provides:
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.
The parties disagree over whether the AWP statute applies to Blue Cross’s PPO plan. The superior court was correct in concluding that the AWP statute does not apply.
Under Georgia law, PPO plans are governed principally by the Preferred Provider Arrangements Act, OCGA§ 33-30-20 et seq. (the “Preferred Provider Act”). When enacting the Preferred Provider Act, the General Assembly announced its intent “to encourage health care cost containment while preserving quality of care by allowing health care insurers to enter into preferred provider arrangements.” OCGA § 33-30-21. In other words, the General Assembly expressed its intention that health care insurers be allowed to contract with their *537“preferred” providers to offer specified covered services, rather than be forced to admit “every” qualified provider, as would be required under the AWP statute.
The intent of the General Assembly is further spelled out in OCGA § 33-30-25, entitled “Reasonable limits on number or classes of preferred providers,” which states:
Subject to the approval of the Commissioner under such procedures as he may develop, health care insurers may place reasonable limits on the number or classes of preferred providers which satisfy the standards set forth by the health care insurer, provided that there be no discrimination against providers on the basis of religion, race, color, national origin, age, sex, or marital or corporate status, and provided, further, that all health care providers within any defined service area who are licensed and qualified to render the services covered by the preferred provider arrangement and who satisfy the standards set forth by the health care insurer shall be given the opportunity to apply and to become a preferred provider.
There is a clear conflict between the AWP statute and OCGA § 33-30-25: the AWP statute requires the admission of “every” qualified provider, while OCGA § 33-30-25 permits health care insurers offering PPO plans to impose reasonable limits on the number or classes of their preferred providers. Furthermore, the AWP statute affords qualified providers with the “right” to participate, while OCGA § 33-30-25 affords only an “opportunity” to participate in a PPO plan. In sum, the express authority given to health care insurers in OCGA § 33-30-25 to limit the number or classes of providers participating in their PPO plans cannot be reconciled with the notion that “any willing provider” has a right to participate.
In light of this clear conflict between the AWP statute and OCGA § 33-30-25, the terms of OCGA § 33-30-25 must take precedence in the context of preferred provider arrangements. First, given that OCGA § 33-30-25 is the more specific statute addressing restrictions that can be placed on the number or classes of preferred providers in PPO plans, its terms must prevail over those of the more general AWP statute. See OCGA § 33-1-5; Glinton, 271 Ga. at 867. Second, given the conflict between the two statutes, the terms of the later statute, OCGA § 33-30-25, see Ga. L. 1988, p. 1483, § 1, must prevail over the terms of the earlier AWP statute. See Ga. L. 1976, p. 1461, § 1; Glinton, 271 Ga. at 866-867.
*538The majority, however, concludes that there are circumstances under which the AWP statute, rather than OCGA§ 33-30-25, should be applied to PPO plans offered by Chapter 20 health care corporations. In reaching this conclusion, the majority relies upon the initial phrase of OCGA § 33-30-25 — “Subject to the approval of the Commissioner under such procedures as he may develop” — to argue that an insurer cannot limit the number or classes of its preferred providers until it first seeks and obtains the Commissioner’s preapproval. The majority then reasons that the AWP statute applies to a PPO plan offered by a Chapter 20 health care corporation (such as Blue Cross) unless the health care corporation obtains preapproval from the Commissioner to place a limit on the number or classes of its preferred providers pursuant to OCGA § 33-30-25. In other words, in the majority’s view, the AWP statute serves as the default statutory framework for a PPO plan offered by a Chapter 20 health care corporation unless and until the Commissioner gives his preapproval to the specific limitations the corporation seeks to impose under OCGA § 33-30-25.
I disagree with the majority because OCGA § 33-30-25 requires health care insurers to seek and obtain preapproval from the Commissioner for the specific limitations they wish to impose on their preferred provider arrangements only if the Commissioner exercises his discretion and decides that preapproval is necessary. The initial phrase of OCGA § 33-30-25 states that the reasonable limits placed by health care insurers on the number or classes of their preferred providers are “[s]ubject to the approval of the Commissioner under such procedures as he may develop.” (Emphasis supplied.) OCGA § 33-30-25. The word “may” is a term of permissiveness, which authorizes the Commissioner in his discretion to develop preapproval procedures but does not require him to do so. See generally McCorquodale v. State, 233 Ga. 369, 374 (3) (211 SE2d 577) (1974). Hence, the Commissioner is afforded discretion in deciding whether agency preapproval of the specific limitations placed by health care insurers on the number or classes of their preferred providers should be required.
It is undisputed that the Commissioner has not promulgated administrative procedures, pursuant to OCGA§ 33-30-25, requiring health care insurers to seek and obtain preapproval of the specific limitations they wish to place on the number or classes of their preferred providers. The Commissioner, therefore, has exercised his discretion and chosen not to require preapproval. Accordingly, health care insurers are not required to seek and obtain preapproval from the Commissioner because the Commissioner has chosen not to require it as a precondition to an insurer imposing specific limitations *539on the number or classes of its preferred providers. Hence, the majority’s argument that Chapter 20 health care corporations like Blue Cross must seek and obtain the preapproval of the Commissioner to avoid application of the AWP statute to their preferred provider arrangements is misplaced.
Decided March 28, 2012
Reconsideration denied April 12, 2012
King & Spalding, James W. Boswell III, Jessica M. Eames, Chilton D. Varner, for appellant (case no. A11A1871).
Samuel S. Olens, Attorney General, Amy M. Burns, Assistant Attorney General, for appellant (case no. A11A1872).
McKenna, Long & Aldridge, James A. Washburn, Jeffrey R. Baxter, Weissman, Nowack, Curry & Wilco, Ned Blumenthal, Nelson, Mullins, Riley & Scarborough, Jeffrey L. Mapen, for appellees.
Lawson & Moseley, Matthew I. Dowling, Holland & Knight, Robert S. Highsmith, Elizabeth C. Whitworth, amici curiae.
In sum, the AWP statute directly conflicts with OCGA § 33-30-25, which permits Chapter 20 health care corporations and other health care insurers to impose reasonable limits on the number or classes of their preferred providers rather than “any willing provider.” And while OCGA § 33-30-25 affords the Commissioner the discretion to require preapproval of those limits, the Commissioner has chosen not to require preapproval. Consequently, the superior court properly concluded that the AWP statute did not apply to the PPO plan offered by Blue Cross. Because the majority arrives at the opposite conclusion, I respectfully dissent.
I am authorized to state that Presiding Judge Phipps and Judge Miller join in this dissent.

 Specifically, I dissent to Division 1 (a) and to Division 2 to the extent that the majority holds that the AWP statute applies to Blue Cross’s PPO plan. I concur fully in Division 1 (b) and to Division 2 to the extent that the majority holds that the AWP statute is inapplicable to the health maintenance organization operated by Blue Cross Blue Shield Healthcare Plan of Georgia, Inc.