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§ 59A-57A-4 NMSA 1978

Non-emergency care; limitation on charges

Known as the Surprise Billing Protection Act

The act spans §§ 59–59 (13 sections).

Laws 2019, ch. 227, § 4.

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 at an in-network facility does not have the ability or opportunity to choose a participating provider who is available to provide the covered services; or

(2) medically necessary care is unavailable within a health benefits plan's network; provided that "medical necessity" shall be determined by a covered person's provider in conjunction with the covered person's health benefits plan and health insurance carrier.

B. Except as set forth in Subsection A of this section, nothing in this section shall preclude a nonparticipating provider from balance billing for non- emergency care provided by a nonparticipating provider to an individual who has knowingly chosen to receive services from that nonparticipating provider.

Official source: NMOneSource (New Mexico Compilation Commission). Reproduced from public-domain New Mexico statutes; confirm against the official source for the current text. Not legal advice.