- Associated Press - Friday, December 22, 2017

SANTA FE, N.M. (AP) - New Mexico’s top insurance regulator is pushing for new legislation to stop medical providers from hitting patients with unexpected bills for services they thought were covered by their health insurance.

State Insurance Superintendent John Franchini has drafted legislation ahead of the legislative session next month that seeks to ease the burden of surprise health care billing on the patients, The Santa Fe New Mexican reported Thursday.

“It’s a huge issue,” Franchini said. “It’s not right and it’s not fair to the policyholders in our state to be subjected to this type of treatment.”

People who have private health insurance said they are frustrated by the surprise hospital and provider bills and believe that disputing them is unproductive, according to a survey by the Center for Health Policy at the University of New Mexico. The survey - sanctioned by the state Office of the Superintendent of Insurance - interviewed 554 privately insured people from August through September.

The survey found that 20 percent had received surprise bills and 67 percent attempted to take action or dispute them. From those who received a bill, 46 percent of the charges came from a doctor they did not expect, 26 percent from multiple providers and 28 percent from an out-of-network service.

Part of the surprise billing comes from the use of in-network and out-of-network providers. A hospital may be in the network, but services or doctors operating the hospital may not be. New Mexico does not require notification when an outside provider is using a certain hospital or clinic, so it falls on the patient to find out.

Franchini said he is seeking comment from the public on the draft legislation that aims to restrict out-of-network billing for some medical procedures and require more transparency from providers.


Information from: The Santa Fe New Mexican, http://www.sfnewmexican.com

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