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Eddy County Health Care Services Basic Information (PDF of information in middle of page)

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Eddy County Health Services

Linda P. Martinez

Eddy County Administration Complex  Suite 225
101 W. Greene St.  Carlsbad, NM  88220
Phone:  575-887-9511
Fax:  575-628-3871
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Eddy County Health Care Services Basic Information

1. Where do I apply for Health Care Assistance?
An application can be picked up at the medical provider's business office or at the Health Care Services Office at 101 W. Greene St. Suite 225, Carlsbad, NM 88220, 575-887-9511.
2.  What criteria must I meet in order to qualify for assistance?
a.  A person must have been a county resident at  least 90 days prior to having the treatment.
b. The gross family income shall not exceed an amount equal to the established per capita income for Eddy County, as shown in the most recent publication of "Survey of Current Business", published by the US Department of Commerce.  A single person's income cannot exceed an amount equal to the per capita income for Eddy County as listed in the same publication, currently:    FAMILY: - $40,096.00  AND FOR A SINGLE PERSON - $26,731.00
c. A person can only receive County Indigent assistance if that person has no other means of assistance, such as: Insurance, Medicare, Medicaid, Workmen's Compensation or any funding from other agencies.
d. If a person obtains hospital care from a hospital not located in Eddy County, the submitting hospital shall provide proof (1) that the treatment was required, (2) that the treatment was not available at a hospital located within Eddy County and (3) that the patient was transferred to the hospital by an Eddy County hospital or  that the admitting physician was asked to provide medical care to the patient by a written referral from an Eddy County physician.  Licensed, out-of-state hospitals must also provide proof that the treatment was not available in an in-state hospital.
3. What is required when I return my application?
a.  A signed copy of all household members' most recent tax returns.  (If a tax return was not required to be filed for  Federal or State, the provider will prepare a tax waiver.)
b. Proof of Residency.  (A Tax Return is helpful in determining this, but if you were not required to file, a copy of a utility bill, rent receipt, driver's license or identification card or a Proof of Residency form must be completed.)
c. Verification of Income. (Four [4] current check stubs (not more than 3 months old) reflecting gross income, Social Security Benefits, V.A. Benefits, General Assistance, Food Stamps, Child Support, Unemployment Compensation, Worker's Compensation or any other source of income.
d.  If no income, provide proof of support for basic needs or letter verifying  support from family or friends, to include their name and address.
4.  Where do I return my application?
Your application should be returned to the local medical provider.  If the provider is located out of the county, your application should be returned to the County Health Care Services Office,  101 W. Greene St., Suite 225, Carlsbad, NM, 88220.  Office hours are from 8:00 a.m. to 5:00 p.m., Monday - Friday, unless there is a holiday.
5.  Is there a time limit for applying?
You must apply within  60 days from the date your medical services were provided.  Please  try to apply as soon as possible to allow the provider time to obtain all required information necessary to submit your claim.  Claims are  presented to the Eddy County Indigent Health Care Board on a monthly basis.  Notification of claim status (approval/denial) will be mailed to the claimant within seven (7) days of the Board's review of the claim.

Services Paid for by The Eddy County Health Services Fund

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.

Limitations

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.