A. An individual or group health maintenance organization contract that is delivered, issued for delivery or renewed in this state and that provides coverage for gynecological or obstetrical ultrasounds shall not require prior authorization for gynecological or obstetrical ultrasounds.

Terms Used In New Mexico Statutes 59A-46-41.2

  • Contract: A legal written agreement that becomes binding when signed.
  • Precedent: A court decision in an earlier case with facts and law similar to a dispute currently before a court. Precedent will ordinarily govern the decision of a later similar case, unless a party can show that it was wrongly decided or that it differed in some significant way.

B. Nothing in this section shall be construed to require payment for a gynecological or obstetrical ultrasound that is not:

(1)     medically necessary; or

(2)     a covered benefit.

C. As used in this section, “prior authorization” means advance approval that is required by a health maintenance organization as a condition precedent to payment for

medical care or related benefits rendered to a covered person, including prospective or utilization review conducted prior to the provision of covered medical care or related benefits.

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