{"data":{"id":"us-nm/59a-57a-4","jurisdiction":"us-nm","citation":"59A-57A-4","heading":"Non-emergency care; limitation on charges.","body":"A. Other than applicable cost sharing that would apply if a participating provider had rendered the same services, a health insurance carrier shall provide reimbursement for and a covered person shall not be liable for charges and fees for covered non-emergency care rendered by a nonparticipating provider that are delivered when:\n(1) the covered person at an in-network facility does not have the ability or opportunity to choose a participating provider who is available to provide the covered services; or\n(2) medically necessary care is unavailable within a health benefits plan's network; provided that \"medical necessity\" shall be determined by a covered person's provider in conjunction with the covered person's health benefits plan and health insurance carrier.\nB. Except as set forth in Subsection A of this section, nothing in this section shall preclude a nonparticipating provider from balance billing for non- emergency care provided by a nonparticipating provider to an individual who has knowingly chosen to receive services from that nonparticipating provider.","path":["Chapter 59A - Insurance Code","ARTICLE 57A Surprise Billing Protection"],"source_url":"https://nmonesource.com/nmos/nmsa-unanno/en/item/18562/index.do","current_through":"2026-07-01","vintage":"","retrieved_at":"2026-09-03T15:02:20Z","sha256":"d706a32bf8f36b48183375aba39cdb70292419ddd3b6b4648ec0e08b33e8704a","source_id":"us-nm","stale":false,"prev":"us-nm/59a-57a-3","next":"us-nm/59a-57a-5"},"notice":"GroundRules: Original legal text. Not legal advice."}