20 percent of New Mexicans Get "Surprise" Medical Bills

Ever been surprised by a big medical bill that you thought your insurance company was supposed to have paid?

Well, you're not alone.

According to a study by the New Mexico Office of the Superintendent of Insurance, 20 percent of privately insured New Mexicans have received a surprise medical bill, meaning a bill they were not expecting to pay or where the health plan paid less than expected.

(Photo: New Mexico Insurance Superintendent John Franchini said he's ask the state Legislature to clamp down on surprise medical bills.)

The study’s findings were largely in line with national trends on surprise billing for out-of-network services. Approximately 20 percent of privately insured respondents received a surprise medical bill, said the study, which was conducted in cooperation with the Robert Wood Johnson Foundation at the University of New Mexico.

These rates were higher for those who had surgery (36 percent) or had a visit to the emergency room (55 percent). Among individuals who received a surprise medical bill, 46 percent got a bill from a doctor they did not expect to get a bill from, 26 percent indicated that they received separate bills from multiple providers, and 28 percent indicated that they were charged an out-of-network rate when they thought the provider was in-network.

Insurance Superintendent John Franchini said he will go to the state Legislature in 2019 to ask for an end to such surprise bills. His office has posted a draft a a proposed bill on its website.

“The Office of the Superintendent of Insurance is committed to eliminating surprises in medical bills,” Franchini said. “The results of the study reinforce our decision to actively engage stakeholders to find a legislative resolution to keep consumers out of the middle of payment disputes that should rightly be resolved between health care providers and carriers.

“We have posted proposed legislation on our website for feedback and plan on working with legislators to introduce a consensus bill during the 2019 legislative session.”

Franchini said that New Mexico is unique in that it has protections for consumers who receive surprise medical bills for out-of-network emergency care. Consumers who obtain emergency care at out-of-network facilities or from out-of-network doctors at in-network facilities are only responsible for paying in-network charges. Health insurance carriers and providers are required to negotiate payment of the remainder of the bill without involving the consumer.

The OSI received approximately 554 responses to its online questionnaire about surprise billing.