Section 59A-57A-3 - Emergency care; reimbursement; limitation on charges. (Effective January 1, 2020.)

NM Stat § 59A-57A-3 (2019) (N/A)

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A. A health insurance carrier shall reimburse a nonparticipating provider for emergency care necessary to evaluate and stabilize a covered person if a prudent layperson would reasonably believe that emergency care is necessary, regardless of eventual diagnosis.

B. A health insurance carrier shall not require that prior authorization for emergency care be obtained by, or on behalf of, a covered person prior to the point of stabilization of that covered person if a prudent layperson would reasonably believe that the covered person requires emergency care.

C. A health insurance carrier may impose a cost-sharing or limitation of benefits requirement for emergency care performed by a nonparticipating provider only to the same extent that the copayment, co-insurance or limitation of benefits requirement applies for participating providers and is documented in the policy.

D. A health insurance carrier may require an emergency care provider to notify a health insurance carrier of a covered person's admission to the hospital within a reasonable time period after the covered person has been stabilized.

History: Laws 2019, ch. 227, § 3.

Effective dates. — Laws 2019, ch. 227, § 16 made Laws 2019, ch. 227 effective January 1, 2020.

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Section 59A-57A-2 - Definitions. (Effective January 1, 2020.)

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Section 59A-57A-4 - Non-emergency care; limitation on charges. (Effective January 1, 2020.)