NM Health Security Plan: Some Advantages for Providers
To grasp what this statewide, cooperative-style, premium-based Plan would look like, imagine the following:
No insurance company networks, which currently greatly complicate the lives of both providers and patients
One set of prior authorization and formulary rules and data sets for almost all patients we treat
Utilization rules made by an accountable, independent, nonprofit, geographically representative commission, with open meetings and 1/3 of its members representing provider and health facility interests
Every NM resident having comprehensive health coverage
Mental and behavioral health care being covered the same as other medical services
The large patient-care obstacle of out-of-pocket costs being reduced
Patients no longer being confused and worried about what’s covered and how their coverage works
Drug prices being negotiated down to reasonable levels for all patients
No more arguing with multiple insurers regarding the terms of “fair” contracts
Ready access to dispute resolution for financial issues providers might have with the Plan
Lower practice and hospital costs for billing and prior authorizations
Little wasting of health care dollars on marketing of insurance plans and their schemes to only insure the healthy
Far fewer middlemen (clerks and reviewers) making health decisions
Elimination of most of the cost-shifting, for both inpatient and outpatient care
Are you a health care provider? Click on the brochure for more information.
If you’re a health care provider and have questions, please contact Executive Committee member John Mezoff, MD.