On May 30, 2023, the Office of Superintendent of Insurance released Bulletin 2013-013 as a public reminder to New Mexico health insurance carriers that the state's Patient Protection Act (PPA) obligates managed healthcare plans to provide "reasonably accessible health care services that are available in a timely manner," including coverage of out-of-network services when "medically necessary covered services are not reasonably available through participating providers."
The bulletin indicates that the superintendent has knowledge of recent incidents where carriers are administratively denying coverage by out-of-network providers, contrary to the PPA's requirements, and makes clear that violations are subject to enforcement actions which include administrative penalties of up to $10,000 per violation, suspension of any certificate of authority or license issued under the Insurance Code, and private remedies available to both patients and providers.
Employers that offer managed healthcare plans in the state to their employees should be aware of this recent bulletin.