Groundbreaking Report Reveals Health Care Billing Frustrations: Insights from New Mexico University’s Center for Social Policy

The University of New Mexico’s Center for Social Policy recently shared findings from interviews with local health professionals and claims processors. Authored by Dr. Melanie Sonntag and Dr. Gabriel Sanchez, the report highlights their frustrations with a complicated billing and claims system in New Mexico’s healthcare landscape.

While many studies discuss the overall costs and challenges of healthcare billing in the U.S., this report is unique. It’s the first to collect detailed feedback directly from those experiencing these issues in New Mexico.

According to the report, the medical billing cycle is “highly complex and time-intensive.” This complexity can negatively affect patient care and the well-being of healthcare workers. For instance, frequent changes in claims processing rules and delays caused by prior authorizations can slow down necessary treatments. Claims denials cause loss of revenue, and payments are often only made to in-network providers. These issues disproportionately affect rural communities, where access to care is already a challenge.

This report is part of broader efforts by the Legislative Health and Human Services Committee (LHHSC). Their cost drivers project aims to explore the root causes of rising healthcare expenses in New Mexico. They have teamed up with experts to analyze data and suggest solutions.

In a July meeting, Dorothy Moller presented a draft report on reducing pharmaceutical costs in the state. Dr. Miriam Laugesen is examining ways to simplify billing and coding systems, while Dr. Michael Gusmano studies the financial sustainability of New Mexico’s Medicaid managed care program, especially crucial as federal budgets face cuts.

In the upcoming legislative session, LHHSC plans to ask for funding to continue this important work. Addressing systemic issues is vital, rather than just increasing state spending.

Grassroots organizations, linked under the Health Security for New Mexicans Campaign, are advocating for a more affordable healthcare system. They have conducted three independent studies over the past 30 years, showing that a plan like Health Security could save hundreds of millions within five years by tackling key health cost drivers.

The Health Security Plan would not only help control costs but also ensure quality coverage, maintain provider choice, and be managed by a board representing diverse community voices.

For more details, the full report is available at the University of New Mexico’s website.

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