2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 22 - Health Insurance Contracts › Section 59A-22-32 - Freedom of choice of hospital and practitioner.

A. Within the area and limits of coverage offered an insured and selected by the insured in the application for insurance, the right of a person to exercise full freedom of choice in the selection of a hospital for hospital care or of a practitioner of the healing arts or optometrist, psychologist, podiatrist, physician assistant, certified nurse-midwife, registered lay midwife or registered nurse in expanded practice, as defined in Subsection B of this section, for treatment of an illness or injury within that person's scope of practice shall not be restricted under any new policy of health insurance, contract or health care plan issued after June 30, 1967 in this state or in the processing of a claim thereunder. A person insured or claiming benefits under any such health insurance policy, contract or health care plan providing within its coverage for payment of service benefits or indemnity for hospital care or treatment of persons for the cure or correction of any physical or mental condition shall be deemed to have complied with the requirements of the policy, contract or health care plan as to submission of proof of loss upon submitting written proof supported by the certificate of any hospital currently licensed by the department of health or any practitioner of the healing arts or optometrist, psychologist, podiatrist, physician assistant, certified nurse-midwife, registered lay midwife or registered nurse in expanded practice.
B. As used in this section:
(1) "hospital care" means hospital service provided through a hospital that is maintained by the state or a political subdivision of the state or a place that is currently licensed as a hospital by the department of health and has accommodations for resident bed patients, a licensed professional registered nurse always on duty or call, a laboratory and an operating room where surgical operations are performed, but "hospital care" does not include a convalescent or nursing or rest home;
(2) "practitioner of the healing arts" means a person holding a license or certificate authorizing the licensee to offer or undertake to diagnose, treat, operate on or prescribe for any human pain, injury, disease, deformity or physical or mental condition pursuant to:
(a) the Chiropractic Physician Practice Act [Chapter 61, Article 4 NMSA 1978];
(b) the Dental Health Care Act [Chapter 61, Article 5A NMSA 1978];
(c) the Medical Practice Act [Chapter 61, Article 6 NMSA 1978];
(d) Chapter 61, Article 10 NMSA 1978; and
(e) the Acupuncture and Oriental Medicine Practice Act [Chapter 61, Article 14A NMSA 1978];
(3) "optometrist" means a person holding a license provided for in the Optometry Act [Chapter 61, Article 2 NMSA 1978];
(4) "podiatrist" means a person holding a license provided for in the Podiatry Act [Chapter 61, Article 8 NMSA 1978];
(5) "psychologist" means a person who is duly licensed or certified in the state where the service is rendered and has a doctoral degree in psychology and has had at least two years of clinical experience in a recognized health setting or has met the standards of the national register of health service providers in psychology;
(6) "physician assistant" means a person who is licensed by the New Mexico medical board to practice as a physician assistant and who provides services to patients under the supervision and direction of a licensed physician;
(7) "certified nurse-midwife" means a person licensed by the board of nursing as a registered nurse and who is registered with the public health division of the department of health as a certified nurse-midwife;
(8) "registered lay midwife" means a person who practices lay midwifery and is registered as a registered lay midwife by the public health division of the department of health; and
(9) "registered nurse in expanded practice" means a person licensed by the board of nursing as a registered nurse approved for expanded practice pursuant to the Nursing Practice Act [Chapter 61, Article 3 NMSA 1978] as a certified nurse practitioner, certified registered nurse anesthetist, certified clinical nurse specialist in psychiatric mental health nursing or clinical nurse specialist in private practice and who has a master's degree or doctorate in a defined clinical nursing speciality and is certified by a national nursing organization.
C. This section shall apply to any such policy that is delivered or issued for delivery in this state on or after July 1, 1979 and to any existing group policy or plan on its anniversary or renewal date after June 30, 1979 or at expiration of the applicable collective bargaining contract, if any, whichever is later.
History:
Laws 1984, ch. 127, § 454; 1985, ch. 192, § 1; 1987, ch. 81, § 1; 1987, ch. 259, § 21; 1989, ch. 96, § 1; 2003, ch. 343, § 2; 2008, ch. 9, § 5.
ANNOTATIONS
Cross references.
— For drug prescriptive, distributing and administering authority of certified nurse midwives,
see
24-1-4.1 NMSA 1978.
The 2008 amendment,
effective May 14, 2008, added "physician assistant" in Subsection A and added the definition of "physician assistant" in Paragraph (6) of Subsection B.
The 2003 amendment,
effective June 20, 2003, substituted "department of health" for "health and environment department" throughout the section; in Paragraph B (2), deleted the reference to Chapter 61, Article 4, 5, 6, 10 or 14A NMSA 1978 and added Subparagraphs B(2)(a) through (e); in Paragraphs B(3) and (4) substituted a reference to the named act for the reverence to the chapter and article; in Paragraphs B(6) and (7), substituted "public health division" for "health services division".
Compiler's notes.
— The annotations appearing below were abstracted from attorney general opinions decided under former 59-18-19 NMSA 1978 which contained provisions similar to this section.
Insurer may not designate practitioners.
— This section provides that an insurer or health care plan may not limit the right of an insured or subscriber to select his own physician, nor may they restrict the choice of the insured or subscriber to a list of practitioners designated by the insurer or health care plan. To so restrict the freedom of choice of the insured or subscriber to a designated list of practitioners would be in clear contravention of this section. 1977 Op. Att'y Gen. No. 77-13.
Insurer may not limit payments for particular profession.
— An insurer or health care plan may not so limit the benefits to be paid for the services rendered by a particular profession of health care providers so as to effectively limit the freedom of choice of the insured or subscriber, and thus defeat the legislative mandate of the section. 1977 Op. Att'y Gen. No. 77-13.
Insured may choose chiropractors.
— The restriction of this section prohibiting discrimination against an insured in the choice of a practitioner of the healing arts, applies to chiropractors. 1972 Op. Att'y Gen. No. 72-58.
Limits of insured's freedom of choice.
— The section provides for freedom of choice by the insured or subscriber in the selection for health care treatment of a hospital or practitioner of the healing arts, optometrist or podiatrist. However, this freedom of choice is limited to those areas of coverage offered in the insurance policy or health care plan, and by the stated limits of the policy or plan. The choice of practitioner is also limited to treatment of an illness or injury that is within the scope of practice of the health care purveyor selected by the insured or subscriber. 1977 Op. Att'y Gen. No. 77-13.
Applies to nonprofit health care plans.
— Nonprofit health care plans organized under former 59-19-1 NMSA 1978 et seq. were required to comply with the provisions of this section relating to freedom of choice of a subscriber in the selection of a physician, osteopath, dentist or chiropractor. 1977 Op. Att'y Gen. No. 77-13.
Accident and health insurance, contract or health care.
— Under the language of this section, the freedom of choice provisions of this section are made applicable to policies of accident and health insurance, and to contract or health care plans. 1977 Op. Att'y Gen. No. 77-13.
Am. Jur. 2d, A.L.R. and C.J.S. references. —
What constitutes mental illness or disorder, insanity, or the like, within provision limiting or excluding coverage under health or disability policy, 19 A.L.R.5th 533.