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New Mexico Statutes Chapter 59A. Insurance Code § 59A-57A-4. Non-emergency care; limitation on charges

Current as of January 01, 2024 | Updated by Findlaw Staff

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.

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Cite this article: FindLaw.com - New Mexico Statutes Chapter 59A. Insurance Code § 59A-57A-4. Non-emergency care; limitation on charges - last updated January 01, 2024 | https://codes.findlaw.com/nm/chapter-59a-insurance-code/nm-st-sect-59a-57a-4/

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