Section 59A-57A-6 - Covered persons; providers; overpayment. (Effective January 1, 2020.)

NM Stat § 59A-57A-6 (2019) (N/A)

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A. If a covered person pays a nonparticipating provider more than the in-network cost-sharing amount for services provided under circumstances giving rise to a surprise bill, the nonparticipating provider shall refund to the covered person within forty-five calendar days of receipt of payment from the health insurance carrier any amount paid in excess of the in-network cost-sharing amount.

B. If a nonparticipating provider has not made a full refund to the covered person of any amount paid in excess of the in-network cost-sharing amount to the covered person within forty-five calendar days of receipt, interest shall accrue at the rate set for payment of interest on a health plan's liability for clean claims submitted by eligible providers to a health plan pursuant to Chapter 59A, Article 16 NMSA 1978.

C. A covered person may seek recovery of the refund of the amount the covered person has paid in excess of the in-network cost-sharing amount that a nonparticipating provider owes, plus interest, pursuant to Subsection B of this section by filing an appeal with the office of superintendent of insurance. The superintendent of insurance shall develop an appeals process pursuant to this section.

History: Laws 2019, ch. 227, § 6.

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

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Section 59A-57A-5 - Credit against maximum out-of-pocket cost-sharing amount; communication by hospitals; advance notification of charges for health care services. (Effective January 1, 2020.)

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Section 59A-57A-7 - Nonparticipating providers; rebates and inducements; prohibition. (Effective January 1, 2020.)