Eddy County Health Care Services Basic Information (PDF of information in middle of page)
1. Hospital services (certified in-state providers, in-patient and out-patient charges) determined medically necessary to the patient. Emergency room care, only when ordered by a physician.
2. Ambulance services provided by specialized carriers based within the state of New Mexico and approved by the Indigent Hospital and County Health Care Board.
3. Psychiatric hospital care only in emergency situations where there exists the likelihood of serious harm to oneself or to others.
PLEASE NOTE: THE EDDY COUNTY HEALTH CARE SERVICES FUND DOES NOT PAY DOCTORS, DENTISTS, RADIOLOGISTS, ANESTHESIA BILLS OR PRESCRIPTIONS.
1. Claims whose payment would be less than $500.00 are not eligible for indigent reimbursement.
2. In-patient hospital payments shall be determined on a per diem basis. The per diem amount will be determined by an audit of the hospital records to determine the actual cost of providing care to the patient. Out of county hospitals will be paid at one half of their audited rate. If no audit has been done on an out of county hospital, it shall be reimbursed at a rate equal to one half the rate of the lesser amount paid to hospitals in Eddy County.
3. Outpatient payments to hospitals will be limited to the gross Medicare reimbursement rate as determined by an audit for the care provided.
4. A limit of one (1) pregnancy will be allowed per client with a maximum of obstetrics benefits of $5,000.00. This excludes elective termination of pregnancy unless necessary to save the life of the mother.
5. Payments for psychiatric care will not be made for any one patient in excess of two psychiatric claims in any period of twelve consecutive months. Psychiatric hospital care does not include counseling or other therapy, which may be in addition to the usual and customary charges for nursing services or on psychiatric wards (usually expressed in terms of "room per day" charges.)
6. The maximum allowed on any one claim is $15,000.00. The maximum in lifetime benefits is $30,000.00 for any one patient.
7. Ambulance service will be reimbursed at 70% of the billed amount with a limit of $1,500.00 per claim.