Surprise medical billings surveyed

Nearly one-third of NM patients receive larger, out-of-network charges

SANTA FE — Nearly onethird of medical patients in New Mexico say they have received large surprise bills over the past two years for services that were outside their insurance provider’s network, an ongoing survey by state regulators has found.

Preliminary results of the statewide survey were announced by the Office of the Superintendent of Insurance in advance of a meeting Thursday of patient advocates and health industry stakeholders in Albuquerque to discuss possible consumer protection reforms.

State Insurance Superintendent John Franchini said preliminary results of the poll on surprise billing show that 31 percent of respondents were charged for medical care that they thought was in-network at more expensive out-of-network rates.

Franchini said the findings, funded by a grant from the federal Centers for Medicare and Medicaid Services, highlight the need for consumer-protection reforms modeled after legislation in other states.

A New Mexico bill introduced in February would have helped resolve charges for out-of-network medical care provided without a patient’s consent. The proposed Surprise Billing Protection Act never came to a floor vote before the Legislature adjourned in March.

Heather Widler, a spokeswoman for the Office of the Superintendent of Insurance, cautioned that final results of the survey could shift as more is learned about billing practices in rural areas.

“What we’ve seen so far is that New Mexico is faring much worse than the national trend,” she said.

At the same time, the survey found about two-thirds of medical patients took action to resolve bills in which the health plan appeared to pay much less than warranted.

Barbara Webber, executive director of the consumer group Health Action New Mexico, says surprise out-of-network billing can arise during surgeries when a member of the medical team is from outside the patient’s provider network.

She said patients often follow referrals to out-of-network medical specialists without seeking insurance authorization first — only to get hit with a big bill later.

The New Mexico Office of the Superintendent offers to help consumers who file complaints over medical billing.