Credit against maximum out-of-pocket cost-sharing amount; communication by hospitals; advance notification of charges for health care services
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, the department of health shall require each health facility licensed pursuant to the Public Health Act [Chapter 24, Article 1 NMSA 1978] to post the following on the health facility’s website in a publicly accessible manner:
(1) the names and hyperlinks for direct access to the websites of all health insurance carriers with which the hospital has a contract for services;
(2) a statement that sets forth the following:
(a) services may be performed in the hospital by participating providers as well as nonparticipating providers who may separately bill the patient;
(b) providers that perform health care services in the hospital may or may not participate in the same health benefits plans as the hospital; and
(c) prospective patients should contact their health insurance carriers in advance of receiving services at that hospital to determine whether the scheduled health care services provided in that hospital will be covered at in-network rates;
(3) the rights of covered persons under the Surprise Billing Protection Act; and
(4) instructions for contacting the superintendent.
D. Any written communication, other than a receipt of payment, from a provider or health insurance carrier pertaining to a surprise bill, shall clearly state that the covered person is responsible only for payment of applicable in-network cost-sharing amounts under the covered person’s health benefits plan. A collection agency collecting medical debt from New Mexico residents shall post a notice of consumer rights pursuant to the Surprise Billing Protection Act on its website.
E. When a nonparticipating provider under nonemergency circumstances has advance knowledge that the nonparticipating provider is not contracted with the covered person’s health insurance carrier, the nonparticipating provider shall inform the covered person of the nonparticipating provider’s nonparticipating status and advise the covered person to contact the covered person’s health insurance carrier to discuss the covered person’s options.
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