Rep. Nathan Small has introduced SB 207, the Surprise Billing Protection Act to protect consumers from this unfair billing practice. If you have a story to tell please send it to PAIGE.DUHAMEL@state.nm.us in the Office of the Superintendent of Insurance who is in support of this bill.
Surprise medical billing occurs when an insured person is treated by an out-of-network provider that the patient had no role in choosing. This occurs most frequently in medical emergencies or major surgery situations when an insured person is treated 1) at an in-network facility for a medical or behavioral emergency and services are provided by ancillary out-of-network providers (surgeon, radiologist, anesthesiologist, pathologist) or 2) patient receives in-patient surgery by an out-of-network provider (physician or ancillary providers) without consent of insured person and is hospitalized or 3) with elective inpatient admissions at in-network facilities.
These surprise bills can be quite large. Patients may receive bills from multiple providers. One study showed that ambulance rides were billed out-of-network roughly half of the time.
The goals of the bill are to:
1) Limit the amount billed for out-of- network emergency room care to what the patient would owe an in-network provider,
2) Limit the amount billed for major surgery costs provided by out-of-network providers to what the patient would owe an in-network provider,
3) Advise emergency patients that they could run up excess charges if they are in an out-of- network hospital; obtain statement signed by patient that they have been told and understand
4) Eliminate “Balance Billing” or the ability of a provider to bill a covered person for the difference between the provider’s billed charges and the amount allowed by the insurance plan. Payment disputes would be resolved by physicians and insurance and not involve consumers.
* The New Mexican Patient Protection Act allows insurers to bill only what a patient would owe an in-network provider for out-of-network emergency care.
There have been other efforts to regulate health care plans to mitigate surprise billing, including a bill introduced in Congress in 2017 by now Governor Michelle Lujan Grisham, “The Fair Billing Act of 2017.” Without federal legislation, states are stepping forward to regulate plans themselves. Other considerations are to establish legislative guidelines for out-of-network providers to seek more payment from insurance carriers based on a formula set up by either state rules or through a federal formula.
The Medicare for All Calculator is a free, online, user-friendly tool based on a proposed financing plan for H.R. 676, the Expanded and Improved Medicare for All bill in Congress. With this calculator,mfacalc.com, anyone can enter information anonymously about the number of people in the household with health insurance, their current income, a typical year’s health insurance premium and out of pocket health costs. Once this information is entered the calculator will determine the savings (in most cases) that HR 676 would provide if enacted.
H.R. 676 would expand Medicare to cover all Americans, regardless of age, income or disability. It eliminates ALL individual healthcare costs, premiums, co-pays and deductibles. It adds comprehensive healthcare coverage, including dental, vision, mental health, long-term care, prescription drugs and other benefits.
We are indebted to Kris Hardy, owner of Albuquerque Software for his role in developing the Medicare for All Calculator. And to Health Action New Mexico for their sponsorship.
A group of concerned citizens, many who are former healthcare providers and associates, have formed the Medicare for All Speakers Bureau. We have created a 30 minute Power Point presentation which compares single-payer health system myths vs facts, gives the pertinent points of the bill and a picture of the financial analysis done by Gerald Friedman, PhD., Economics Professor at the University of Massachusetts at Amherst, on how to pay for this bill if enacted, “Funding HR 676”, published in 2013.
If your group would like to schedule a presentation email firstname.lastname@example.org for more information.
NM Legislative Action Alerts for 2019 from PDA Central New Mexico Chapter
Stay actively engaged with justice- and progressive-oriented legislation during the 2019 NM Legislative Session
The 2019 legislative session will soon be upon us, and we are getting ready for action!
Once again, PDA will be sending ACTION ALERTs on progressive legislation that is scheduled to be heard and debated in committees of the New Mexico Legislature.
These alerts will tell you how to contact your legislator and what to say when you do.
Each alert provides basic information about the legislation.
A quick link to open an email to each legislator on the committee that is considering the bill.
The legislator’s telephone number so you can call with your message.
Be a Citizen Activist and receive these easy-to-follow alerts. Sign up by: emailing Paul Stokes at email@example.com with the subject “Add me to your action alert email list”. Please include your name in the body of the email.
REMINDER: Legislative session dates:
Legislation may be pre-filed – December 17, 2018
Session begins – January 15, 2019
Deadline for introduction of legislation – February 14, 2019
Session ends – March 16, 2019
Together, we can make the changes that bring justice and well-being for all New Mexicans.
Thank all you PDACNM supporters for contributing Dignity Kits for asylum seekers. Here is Deborah Marez-Baca beside a rented van stuffed to capacity with hundreds of Dignity Kits donated by many friends of PDACNM. Deb and husband Larry drove to El Paso over the Thanksgiving weekend and delivered the kits to those in need at the border. We will be making more deliveries in the future of whatever items the agencies think are necessary to help these courageous and desperate migrants seeking safety.
Emma’s artwork for “Bridging Two Worlds” Emma created this poster artwork for “Telling My Story: Bridging Two Worlds,” to be presented in November by Two Worlds and Storytellers of New Mexico. Mark your calendars for this interactive storytelling/theater performance featuring all women of color: November 9th -11th at the Q-Staff Theatre in Albuquerque. There is more information at www.storytellersofnewmexico.com and in the next issue of UNTITLED.
This year is pivotal for shifting the balance of forces in the United States away from the proponents of austerity, racism, war and fascism. People are coming together not only to resist Trump and the Republicans but to fight for economic and social survival. Health care in the US is a raging cauldron of struggle to win justice as millions campaign for access, affordability, quality and equality. Single-payer financing is increasingly recognized as essential for a just healthcare system.
The drive toward “Building a Pathway to Victory” has begun and was the focus of this year’s national single-payer strategy conference. The Minnesota Nurses Association hosted this historic meeting in Minneapolis June 22-24. Initially funded by National Nurses United, this campaign seeks to make healthcare justice, including the enactment of expanded and improved Medicare for all, an essential ingredient in the 2018 and 2020 elections. Support for improved Medicare for all has already shown itself to be a winner in Democratic Party primaries across the country, North and South. Organizers have been hired to work in key presidential primary states. Regional meetings to launch this campaign have so far drawn hundreds more activists into the fray.