2020 New Mexico Statutes
Chapter 59A - Insurance Code
Article 57A - Surprise Billing Protection
Section 59A-57A-6 - Covered persons; providers; overpayment.
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.
ANNOTATIONSEffective dates. — Laws 2019, ch. 227, § 16 made Laws 2019, ch. 227 effective January 1, 2020.
