SENATE MEMORIAL 55

54th legislature - STATE OF NEW MEXICO - first session, 2019

INTRODUCED BY

Gerald Ortiz y Pino

 

 

 

 

 

A MEMORIAL

REQUESTING THE SUPERINTENDENT OF INSURANCE TO CONVENE A GROUP OF STAKEHOLDERS WITH EXPERTISE IN THE AREAS OF HEALTH CARE DELIVERY, HEALTH COVERAGE AND HEALTH CARE FINANCE TO STUDY AND REPORT ON THE LIKELY EFFECTS OF MANDATORY ASSIGNMENT OF BENEFITS LEGISLATION REQUIRING INSURERS TO ACCEPT AN ASSIGNMENT OF BENEFITS FROM A NON-CONTRACTED HEALTH CARE PROVIDER.

 

     WHEREAS, an assignment of benefits form executed by a patient may allow a health care provider to directly bill and be paid by a patient's health insurance company; and

     WHEREAS, most patients elect to assign health insurance benefit payments directly to their health care provider at the initial intake appointment; and

     WHEREAS, a health care provider will submit a claim for payment to a patient's insurance company with a copy of the patient's executed assignment of benefits form; and

     WHEREAS, a patient may have visited a health care provider who is not contracted with the patient's insurance company and is therefore considered "out-of-network" by the patient's insurance company; and

     WHEREAS, many insurance companies do not honor a patient's assignment of benefits for out-of-network costs; and

     WHEREAS, the insurance company may include in its contract with the patient a clause prohibiting assignment of benefits for out-of-network costs; and

     WHEREAS, an insurance company often sends reimbursements for out-of-network costs directly to a patient rather than the health care provider, leaving the health care provider to spend time and money on billing and collection; and

     WHEREAS, putting a health care provider in a position that requires billing and collection of an outstanding and sometimes unexpected bill may undermine the trust in the relationship between the provider and patient; and

     WHEREAS, assignment of benefits is integral to the management of a health care provider's practice, and efficient payment lowers costs for health care providers and patients; and

     WHEREAS, however, a patient receiving payment directly from an insurer may improve the patient's ability to negotiate lower health care costs; and

     WHEREAS, requiring insurance companies to pay health care providers directly for out-of-network services may incentivize health care providers to avoid contracting with a health insurance network; and

     WHEREAS, if health care providers do not join health insurance networks, patients may therefore lose contracted health insurance network discounts, raising costs for patients; and

     WHEREAS, assignment of benefits forms may also include the assignment of the right to sue for payment on behalf of the patient and may therefore involve the patient in unwanted litigation; and

     WHEREAS, the federal Employee Retirement Income Security Act of 1974 may prevent state law from effectively requiring enforcement of assignment of benefits forms for certain claims; and

     WHEREAS, according to an article published in 2011 in the Indiana Health Law Review, as of January 2010, nearly one-half of the states had enacted legislation requiring insurance companies to honor patients' assignments of benefits and about one-half of those laws covered only claims by certain health care providers, such as providers of dental or emergency care, while the rest cover several health care providers; and

     WHEREAS, enacting legislation in New Mexico to require insurance companies to honor assignment of benefits forms may have consequences that should be carefully studied;

     NOW, THEREFORE, BE IT RESOLVED BY THE SENATE OF THE STATE OF NEW MEXICO that the superintendent of insurance be requested to convene a "mandatory assignment of health insurance benefits task force", the membership of which shall include experts in the areas of health care delivery, health coverage and health care finance, including representatives from the New Mexico hospital association, the New Mexico association of commerce and industry, the New Mexico medical society, the New Mexico osteopathic medical association, the New Mexico nurses association, health action New Mexico and the New Mexico primary care association, to study the likely impact on health care providers, health care institutions, patients and health care insurers of enacting a law that requires health care insurers to honor properly executed assignment of benefits forms; and

     BE IT FURTHER RESOLVED that the superintendent of insurance be requested to report the results of the mandatory assignment of health insurance benefits task force study to the legislative health and human services committee by November 1, 2019; and

     BE IT FURTHER RESOLVED that copies of this memorial be transmitted to the governor, the chair and vice chair of the legislative health and human services committee, the secretary of human services, the secretary of health and the superintendent of insurance.

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