New Mexico Explores Surprise Bill Legislation

A growing number of states are evaluating legislative and regulatory approaches to protect consumers from unexpected costs for out-of-network emergency services and “surprise” bills from out-of-network providers at in-network facilities. FAIR Health is assisting insurance regulators in several states with comparative FH® Benchmarks for provider charges and insurers’ allowed amounts together with Medicare rates for specific healthcare services that often give rise to surprise bills for consumers. New Mexico is the most recent state to discuss with FAIR Health the role our data might play in such legislation.

At the request of New Mexico’s Office of the Superintendent of Insurance (OSI), FAIR Health conducted a well-attended webinar on July 27, 2017, to assist officials with their outreach to stakeholders for the purpose of developing legislation addressing surprise bills. Our presentation outlined FAIR Health’s history and mission, explained the sources and development of the FH Benchmarks and other products and described the approaches other states have taken in using the FH Benchmarks as standards for healthcare payments. We provided comparisons of FH Benchmarks for charge and allowed amounts for a variety of healthcare services with the fees paid for the same care under New Mexico’s Medicare and Medicaid fee schedules. We then responded to a broad range of substantive questions raised by participants. OSI officials indicated that they plan to seek FAIR Health’s assistance with additional programs as they conduct research and develop their proposal.

FAIR Health President Robin Gelburd stated, “In keeping with our mission to support healthcare cost transparency for consumers and all stakeholders, FAIR Health welcomes the opportunity to assist New Mexico in evaluating the approaches available for crafting appropriate consumer protection legislation in their state.”

For more information about the value FAIR Health data can bring to your state’s development of balance-billing legislation, contact us by e-mail at or call us at 855-301-3247, Monday through Friday, 9 am to 6 pm ET.