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Bill in New Mexico Would End Surprises Caused By Balance Billing

Draft legislation is being circulated in New Mexico that would seek to end the surprises caused by balance billing, when a patient receives a bill for a stay in the hospital that is not covered by insurance.

Balance billing usually occurs in emergency cases when a patient is treated at a facility that is outside of the patient’s insurance network. There have been a number of highly publicized cases where individuals have received bills in excess of $100,000 for treatment that was not covered by insurance.

There was the story of the emergency room doctor who was billed $30,000 for life-saving treatment after suffering an injury while surfing. As well, there was the story of the heart attack patient who received a bill for $109,000.

In New Mexico, the bill, which will be introduced when the state legislature returns next month, would require health insurers to reimburse non-participating providers for emergency care if a “prudent layperson” would believe the emergency care is necessary.

As well, individuals would not be liable for charges and fees if the individual “does not have the ability or opportunity to choose a participating provider who is available to provide the covered services,” or “medically necessary care is unavailable within a health benefits plan’s network.”

Healthcare facilities would be barred from submitting a “surprise bill” to an individual, under the proposed legislation.

Momentum for the legislation in New Mexico has been propelled by a woman who received a $95,000 bill when she was treated for a freak accident that left her in a coma for more than two weeks.

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