New Mexico § 59A-57A-4 Non-emergency care; limitation on charges

New Mexico Statutes

§ 59A-57A-4 — Non-emergency care; limitation on charges

New Mexico § 59A-57A-4

Ch. 59AInsurance Code

Art. 57ASurprise Billing Protection

This text of New Mexico § 59A-57A-4 (Non-emergency care; limitation on charges) is published on Counsel Stack Legal Research, covering New Mexico primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook

N.M. Stat. Ann. § 59A-57A-4 (2026).

Text

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 S

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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.