American Society of Plastic Surgeons
For Consumers

New Mexico: Enforce Network Adequacy

In November, ASPS submitted comments to the New Mexico Superintendent of Insurance (OSI) articulating the Society's concerns with the Agency's draft legislation, the Surprise Billing Protection Act. The proposal favors insurance carriers and lacks meaningful accountability requirements for carriers to ensure that patients have access to specialty care providers, including plastic surgeons.

Detailed in the letter, ASPS strongly rejected the Agency's attempt to force an out-of-network provider to accept the median allowed amount of in-network reimbursements. To ensure physicians receive fair and timely payment, the Society recommended that the OSI use FAIR Health Inc.'s benchmark of 80th percentile of billed amounts to ensure that physicians receive reimbursement that most accurately represents the market rate for out-of-network physicians who are unable to contract a reasonable in-network reimbursement rate. ASPS comments also requested that the OSI clarify facility responsibilities regarding disclosures that inform patients about opportunities to prevent unintentional out-of-network services.

This was not the first attempt by the OSI to reform existing network adequacy and out-of-network standards in the state. In April, ASPS submitted comments to the Agency expressing similar concerns during the rulemaking process for a separate network adequacy proposal. The Society will continue to monitor the regulatory activities of the Agency and work to ensure that strong network adequacy standards are in place in the state.