Sections 1 through 13 [59A-57A-1 to 59A-57A-13 NMSA 1978] of this act may be cited as the “Surprise Billing Protection Act”. History: Laws 2019, ch. 227, § 1. ANNOTATIONS Effective dates. — Laws 2019, ch. 227, § 16 made Laws 2019, ch. 227 effective January 1, 2020.
Except as provided in Subsection C of Section 6 [59A-57A-6 NMSA 1978] of the Surprise Billing Protection Act, nothing in that act shall be construed to create or imply a private cause of action for a violation of that act. History: Laws 2019, ch. 227, § 10. ANNOTATIONS Effective dates. — Laws 2019, ch. 227, […]
The superintendent: A. may require that health insurance carriers report the annual percentage of claims and expenditures paid to nonparticipating providers for health care services; and B. may require by rule a report on changes to the percent of claims paid as an emergency claim. History: Laws 2019, ch. 227, § 11. ANNOTATIONS Effective dates. […]
The provisions of the Surprise Billing Protection Act apply to the following types of health coverage delivered or issued for delivery in this state: A. group health coverage governed by the provisions of the Health Care Purchasing Act [Chapter 13, Article 7 NMSA 1978]; B. individual health insurance policies, health benefits plans and certificates of […]
A. For services provided pursuant to Section 3 [59A-57A-3 NMSA 1978] or 4 [59A-57A-4 NMSA 1978] of the Surprise Billing Protection Act, a health insurance carrier shall directly reimburse a nonparticipating provider for care rendered the surprise bill reimbursement rate for services. B. The surprise bill reimbursement rate shall be calculated using claims data reflecting […]
As used in the Surprise Billing Protection Act: A. “allowed amount” means the maximum portion of a billed charge that a health insurance carrier will pay, including any applicable covered person cost-sharing responsibility, for a covered health care service or item rendered by a participating provider or by a nonparticipating provider; B. “balance billing” means […]
A. A health insurance carrier shall reimburse a nonparticipating provider for emergency care necessary to evaluate and stabilize a covered person if a prudent layperson would reasonably believe that emergency care is necessary, regardless of eventual diagnosis. B. A health insurance carrier shall not require that prior authorization for emergency care be obtained by, or […]
A. Other than applicable cost sharing that would apply if a participating provider had rendered the same services, a health insurance carrier shall provide reimbursement for and a covered person shall not be liable for charges and fees for covered non-emergency care rendered by a nonparticipating provider that are delivered when: (1) the covered person […]
A. A nonparticipating provider shall not knowingly submit a surprise bill to a covered person. B. In accordance with the hearing procedures established pursuant to the Patient Protection Act [Chapter 59A, Article 57 NMSA 1978], a covered person may appeal a health insurance carrier’s determination made regarding a surprise bill. C. By July 1, 2020, […]
A. If a covered person pays a nonparticipating provider more than the in-network cost-sharing amount for services provided under circumstances giving rise to a surprise bill, the nonparticipating provider shall refund to the covered person within forty-five calendar days of receipt of payment from the health insurance carrier any amount paid in excess of the […]
A nonparticipating provider shall not, either directly or indirectly, knowingly waive, rebate, give, pay or offer to waive, rebate, give or pay all or part of a cost-sharing amount owed by a covered person pursuant to the terms of the covered person’s health benefits plan as an inducement for the covered person to seek a […]
A. The superintendent shall convene appropriate stakeholders, including rural providers, insurers and consumer advocates, and review the reimbursement rate for surprise bills annually to ensure fairness to providers and to evaluate the impact on health insurance premiums and health benefits plan networks. B. Calculation of the date of health insurance carrier receipt of a claim […]
Nothing in the Surprise Billing Protection Act shall be construed to prohibit a health insurance carrier from appropriately using reasonable health care cost management techniques. History: Laws 2019, ch. 227, § 9. ANNOTATIONS Effective dates. — Laws 2019, ch. 227, § 16 made Laws 2019, ch. 227 effective January 1, 2020.
